First Name *

Last Name *

Email *

Email (Confirmation) *

Phone *

Address 1 *

Address 2

City *

State/Province *
- Select State Alabama Alaska American Samoa Arizona Arkansas Armed Forces Afr/Can/EU/ME Armed Forces Americas Armed Forces Pacific Baker Island California Colorado Connecticut Delaware Federated State of Micronesia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Midway Islands Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Trust Territory of Pacific Utah Vermont Virgin Islands Virginia Wake Island Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip/Postal *

Oranization *

Job Title *

Are you a CTRS? *
Yes
No

Do you need CEUs? *
Yes
No

Meal Preferences *
Please select at most 4 options
No Restrictions
Vegetarian
Vegan
Gluten-Free
Nut Allergy
Other Food Allergies

Will you need any accommodation to participate in outdoor activities, for accessibility indoors and/or outdoors, or modifications to participation? *
No
Yes

If you answered Yes to this question, please explain so that we can ensure the best possible experience. *

Name *

Relationship *

Phone number *

I acknowledge that no refunds will be given if I cancel within 2 weeks of the workshop. I will contact the workshop organizer if I am unable to attend or wish to transfer my registration to another person.
On-site you will be asked to sign a liability waiver to participate and a photography and media release.
Prior to the workshop, a separate questionnaire will be sent to you to allow the speaker to customize the workshop to individual goals and needs.

If you have any questions, please contact Dr. Dawn DeVries [email protected]

I acknowledge that no refunds will be given if I cancel within 2 weeks of the workshop. *
Yes