Course Application

 

Registration Form  

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

Address:___________________________________________________________________  

Gender:_________ Age_______  

Phone:_____-_____- ______  

Email:_______________________  

Accommodation Information Required: ______  

 

   

 

 

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 when mailing your payment.

Checks should be made to Cloudburst Cultivated Ecology.