Name
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First Name
Last Name
Email Address
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Birthday
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MM
DD
YYYY
Best Time to Contact
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Morning
Afternoon
Evening
What is your present occupation?
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Please describe your roles and responsibilites.
Have you attended any other Permaculture or sustainability course? When, where, and with what teachers?
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What do you want to gain from attending this course?
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What expectations do you have for this course?
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Do you have any questions regarding this course or course content?
Please list any experiences or knowledge you have relating to Permaculture or sustainability (e.g. appropriate technology, food production, design, community work, etc.) Please note if you are comfortable sharing this with the class.
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What are your favorite hobbies, crafts, past-times, or passions?
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Do you have any physical limitations or other restraints?
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Dietary Preferences
Vegetarian
Vegan
Diabetic
Other
If Other, please explain.
Please provide details of your arrival and departure.
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This is so we can assist you and/or make suggestions to ease your traveling experience.
Would you like to upgrade your accommodations?
Cottage: A two-bedroom cottage with greywater system including kitchenette, den, book bar, A/C. Each bedroom boasts a double bed.
Asleep in the Manger: An enclosed 8X8 space with private entrance. Four spots available.
Sharing the Pavilion: A screened pavilion that will hold three snoozers. This is an open space. Three spots available.
Cottage: Single occupancy: $200 (one person, one bedroom) for the entire program.
Cottage: Double Occupancy: $150 each ( two people, one bedroom) for the entire program.
Asleep in the Manger: $100 for the entire program.
Sharing the Pavilion: $50 for the entire program.
Which Scholarship would you like to apply for?
Partial Scholarship ($500 off)
Full Scholarship
Tell us about what you've done and what you hope to do with this knowledge.
References
Three professional references (not your buddies or family):