Vermont Center for Ecostudies · 2022 Winged Wonders Registration Form

Amount

*

$

Attendee Information

Please fill out the registration form for each individual attending the trip.

Name

*

Prefix

First Name

Last Name

Suffix

Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Email

*

Verify Email

*

Phone

*

May we share your email and address with other attendees?

*

Accommodation

Accommodation Request

*

For Double Occupancy - Number of Beds

Name of person I will share a double accommodation with

Emergency Contact Information

Emergency Contact Name

*

Prefix

First Name

Last Name

Suffix

Emergency Contact Phone

*

Physician Office Name

*

Physician Phone

*

Medical Conditions

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N/A if none

Allergies

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N/A if none

Dietary Restrictions

*

N/A if none

Will you attend the optional 1-day extension for Northeast Kingdom birding guided by Nathaniel Sharp?

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Yes

No

Payment

For now, you will pay only the deposit.

Payment Options

*

If you are paying by check, please indicate above and proceed using the "Enter Payment Information" button. Once you proceed to the next screen, we will receive your registration and you may exit the browser.

Please mail your $200 deposit to:

The Vermont Center for Ecostudies
PO Box 420
Norwich, VT 05055

Please indicate the trip name in the check memo. Thank you!

Questions?

Please email Susan Hindinger at shindinger@vtecostudies.org for more information or with any questions.

I certify that I am fully vaccinated and boosted against COVID-19 according to the current CDC recommendations.

*

Yes