Registration Form
Your registration information has been received. Thank you. Continue below for payment options.
You will receive a confirmation e-mail with driving directions, gear requirements and class info from us soon.
If this registration was in error, or you would like to cancel this registration, please click here to let us know. Please be sure to provide your name and which classes you are canceling.
Part 1: Registration Information
Name:Age:
Sex:
Address1:
Address2:
City:
State:
Zip:
Country:
Work Phone:
Home Phone:
E-Mail:
Emergency Contact Name:
Emergency Contact Phone:
Vegetarian/Special Dietary Needs:
If yes, please explain:
Allergies:
If yes, please explain:
Course 1:
Course 1 Date:
Course 2:
Course 2 Date:
Course 3:
Course 3 Date:
Your goals:
How did you hear about us:
Signature:
Signature Date:
Photo Release:
Payment Method:
Date/Time: 10/09/13 : 20:38:21
Part 2: Payment
Pay by PayPal or Credit Card
To pay by credit card, please add the appropriate classes to your shopping cart using the link(s) below:
| Standard Courses |
|
| Half-Day Course: $49 | |
|---|---|
| One-Day Course: $97 | |
| Two-Day Course: $247 | |
| Three-Day Course: $379 | |
| Five-Day Course: $629 | |
| Other Courses |
|
| Survival Challenge Course: $179 | |