Eagle Hill Masthead



Application for Eagle Hill Fall Weekend Workshops

* Denotes required fields

*Full Name
*Phone (day)
Phone (eve)
Phone (cell)
*Address
*City
*State/Province
*Zip/Postal Code
*Email
Age (to be used when making room arrangements)
*Gender Female  Male 
*Alumnus Institute alumnus(a)  1st time applicant 

I would like to participate in the following workshop(s):
*Title
*Instructor
*Dates
Second workshop:
Title
Instructor
Dates
Alternate choice:
Title
Instructor
Dates

What are your specific interests, goals and expectations for the above program(s)?

Which of your experiences, classes, or interests are related to the above programs? What is your current career or career interest and institutional affiliation?

Accomodations are double occupancy, but some single rooms are available. Do you have any personal habits, preferences, or concerns that you would like us to consider when assigning roommates?


Which nights will you be staying at the Institute?
None
Friday
Saturday
Sunday
Other (please specify):

Do you smoke or snore?
Smoke
Snore

Meal plan choice:
full meal plan (required for residents: includes meals from Friday dinner through Sunday lunch)
commuter meal plan (includes dinner on Friday and lunches on Saturday and Sunday)

Do you have any special dietary requirements or food allergies we should be aware of?
No significant dietary restrictions
I am a strict vegetarian
I am a "vegetarian," but I do occasionally eat:
   dairy
   eggs
   chicken
   fish
   shellfish
   other animal products:

I have the following special dietary requirements/allergies:


Are you fully able to participate in field trips, some of which may involve hiking over uneven and/or awkward terrain? Please indicate any concerns you might have and how we might be able to help you.


Do you have any special medical conditions we should be aware of?

Are you requesting a general discount? Only one of the following may be requested.
Year-round resident of Washington or Hancock County (20%)
Institute alumnus(a) of 1 previous seminar (10%)
 Institute alumnus(a) of 2-3 previous seminars (15%)
Institute alumnus(a) of 4+ previous seminars (20%)
University student (10%); with faculty letter of recommendation(20%)
 Couple (10%)
Group (10%)

If you are a student, please list your university or college. If you are an alumnus, please list seminars you have attended.
Are you interested in possibly carpooling if someone inquires? Yes    No
     If yes from where?
Other pertinent information, comments, questions, etc., are welcome:

 In case of emergency, contact:
*Emergency Contact Name
*Emergency Contact Phone
A $50 deposit is required to save your place in the workshop. Once you submit this application, you will be given the option of going to the secure server to pay your deposit (credit cards and PayPal accepted).The balance is due upon arrival.

I grant Eagle Hill Institute the permission to use any photographs taken of me during my participation in the above seminar(s) solely for the purposes of Eagle Hill Institute-related promotional material and publications.

How did you hear about the 2015 Natural History Seminar series?

I understand that during my participation in this seminar, reasonable efforts will be made to assure my comfort and safety both at the host facility and in the field. I recognize my own responsibilities in this regard. Full details on liability are available.

 

E-Commerce site required information ... Contact information - Eagle Hill Institute, PO Box 9, Steuben, ME 04680-0009. Customer service: 207-546-2821 # 1, or office@eaglehill.us.Refund policy: See ... http://www.eaglehill.us/programs/general/application-info.shtml. Privacy statement: We know that you care how information from you is used. We do not share your information with others.

Site by Bennett Web & Design Co.