Hike & Write Registration

by DIG-IT

Nature Writing Workshop by DIG IT! Magazine
Hike & Write

REGISTRATION FORM

 Saturday, April 26, 2014; 10:00am to 1:00pm
 Hacklebarny State Park, 119 Hacklebarney Rd, Long Valley, NJ
 Fee: $35 per person
 Payment must accompany registration (unless pre-arranged)
 Class size is limited; no refunds after April 21
 Please make check or money order payable to Mary Jasch.
 Mail to: Mary Jasch, PO Box 397, Augusta, NJ 07822
 Limited to 15 people. First come; first serve.
 Not handi-capped accessible

Please fill out all fields.

Name (print): ___________________________________________

Street Address:__________________________________________

Town, State, Zip:________________________________________

Home Phone:______________________________________________

Cell phone: _____________________________________________

Email:___________________________________________________

Emergency Contact Name: __________________________________

Emergency Contact Phone: __________________________________

Quantity:______ @$35/person per person Total:____________

How did you hear about the Hike & Write? _________________________________

Questions? Contact Mary: mary@dig-itmag.com

Acknowledgment of Risk
We ask you to acknowledge that there is an element of risk in any adventure, travel, sport, or activity associated with the outdoors. We trust that you know of the inherent risks, dangers, and rigors associated with travel in the outdoors, the risk of travel by car, bus, or other vehicles, the risk of disease or illness, and all that is encountered in the natural world and areas of civilization.

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