Vermont Center for Ecostudies · 2019 Monhegan Island Registration

Contact Information

Name (Please submit one form per person)

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First Name

Last Name

Email

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Verify Email

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Mailing Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone

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Accommodation Preference

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Please choose your accommodation preference here. *Suites have been booked, none available.*

Name of person I will be sharing Double accommodations with:

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First and Last Name of person you are sharing with.

Emergency Information

Emergency Contact Name

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First Name

Last Name

Emergency Contact Phone

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Physician Name

First Name

Last Name

Physician Office Name

Physician Phone

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Medical Conditions

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Please enter any medical conditions or N/A if not applicable.

Allergies

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Please enter any allergies or N/A if not applicable.

Dietary Restrictions:

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Please list any dietary restrictions for you (and guest) or enter N/A if not applicable.

Sharing of Personal Information

We'd like to distribute the trip list (Name, email, and addresses) to all attendees.

May we share your email with attendees?

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Yes

No

If you would like to share a different email than your primary email, enter it here.

Verify Email

May we share your mailing address with attendees?

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Yes

No

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 forms are received.

Full Payment via cash or check is due at the VCE Business Office by June 30th.

Method of Payment - Registration Fee

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Cancellation Policy

Cancel before June 30: full refund, minus registration fee

Cancel between July 1 - Aug 12: 50% refund, minus registration fee

Cancel August 12 or later: no refund

Please confirm that you have read the Cancellation Policy.

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I understand the Cancellation Policy.

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