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Registration Form Please complete and return to: ERC P.O. Box 819 Ketchum, ID 83340 ¨ Water Explorations July 8-12 ¨ Amazing Adaptions July 15-19 ¨ Nature Connections July 29-August 2 ¨ Environmental Outdoor Leadership July 22-26 ¨ Shooting Star Campout August 10-11 Name of Participant: ¨ Male ¨ Female Phone Number: Mailing Address: City, State & Zip:

Grade for 2013-2014 School Year: Email Address:

Parent/Guardian: Emergency Contact: Relationship to participant:

Phone:

Dietary or Medical Restrictions: Cabin Mate Request: *We will do our best, but no guarantees. T-shirt Size: ¨ Small ¨ Medium ¨ Large EcoCamps: $450 Discounts Available ¨ ERC Membership Discount: 7% ¨ ERC Membership: $50 EcoCamp Special: $25 until May 15 ¨ Early bird registration discount before May 15: 5% ¨ Multiple family member discount : $50 Confidential scholarships & payment plans available. ¨ Please send me a scholarship form. A 50% deposit is required to secure your registration. Payment Method: ¨ Check ¨ MasterCard ¨ Visa ¨ Amex Name on Card: Billing Address: City, State, Zip: Credit Card Number: Security Code from Card: Email for receipt:

¨ Discover

Expiration:

call: (208) 726-4333 • e-mail: allison@ercsv.org • visit: www.ercsv.org

EcoCamp Registration Form Full Page  

Registration form

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