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.
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