Vermont Center for Ecostudies · 2023 Monhegan Island Registration Form

Attendee Information

Please fill out the following contact information for yourself.

Name

*

Prefix

First Name

Last Name

Suffix

Address

*

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?

*

Are you registering for a second person in addition to yourself?

*

Yes

No

Second Attendee Information

Please complete this section if you are registering for a second person in addition to yourself.

Second Attendee Name

*

Prefix

First Name

Last Name

Suffix

Second Attendee Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Second Attendee Email

*

Verify Email

*

Second Attendee Phone

*

Second Attendee: May we share your email and address with other attendees?

*

Emergency Contact Information

Emergency Contact Name

*

Prefix

First Name

Last Name

Suffix

Emergency Contact Phone

*

Physician Office Name

*

Physician Phone

*

Medical Conditions

*

N/A if none

Allergies

*

N/A if none

Dietary Restrictions

*

N/A if none

Second Attendee Emergency Contact Information

Second Attendee Emergency Contact Name

*

Prefix

First Name

Last Name

Suffix

Second Attendee Emergency Contact Phone

*

Second Attendee Physician Office Name

*

Second Attendee Physician Phone

*

Second Attendee Medical Conditions

*

N/A if none

Second Attendee Allergies

*

N/A if none

Second Attendee Dietary Restrictions

*

N/A if none

Accommodation

Accommodation Request

*

For Double Occupancy - Number of Beds

Name of person I will share a double accommodation with

Registration Fee and Final Payment Policy

Please submit the $200 Registration Fee per person to officially reserve a spot. No reservation is confirmed until fee and form are received.

All credit card payments will incur a 3% processing fee.

Full Payment is due by June 30th. You will receive a reminder email in early June with a link to pay via credit card or you may mail/deliver a check or cash to the VCE office.

Payment Options

*

Amount

*

$206 - Registration Fee - One Person (including 3% processing fee)

$412 - Registration Fee - Two People (including 3% processing fee)

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 per person deposit to:

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

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

Cancellation Policy

Canel before June 30: full refund, minus registration fee

Cancel July 1 - Aug 17: 50% refund, minus registration fee

Cancel Aug 18 or later: no refund

Please confirm that you have read the Cancellation Policy.

*

I understand the Cancellation Policy

I certify that I am (or we are) fully vaccinated and boosted against COVID-19 according to the current CDC recommendations.

*

Yes

Questions?

Please email Alyssa Fishman at afishman@vtecostudies.org for more information or with any questions.