Cloudburst Cultivated Ecology/Clearlight Permaculture Design

Course Application

Cloudburst Cultivated Ecology

 

19 Elm Street, Suite 11, Glens Falls, NY 12801

 

Permaculture Design Certificate Course

At The Peace-Atorium

Balston Spa, NY

From April 7 – July 7, 2012

 

 

Registration Form 

 

 

 

 

Name:______________________________________( as it will appear on the certificate)

 

Address:___________________________________________________________________

 

 

Gender:_________ Age_______Phone:_____-_____- ______

Email:_______________________

Accommodation Information Required: ______

 

 

 

Applications should be sent with $100 Deposit ~~ Thank you

 

 

 

 

  

We need to know the best method of communicating with you.

· How did you did you hear about us?

Please answer the following questions (one page):

1. Please describe your previous experience, if any (gardening, farming, green building, alternative energy systems, organizing, etc.)

2. What is your interest in this course, and how will this education assist you in the future?
3 Put in to words, briefly what is your background? ( ie: professional/educational)

Please enclose your $100 non-refundable deposit with your application.   Make checks out to Cloudburst Cultivated Ecology.  Thank you.

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