Melting Ice in Vermont

September 4-5, 2008 Intensive Registration Form

Please print legibly when completing this form.

One form per workshop participant.

If you have problems printing this page, you can use this printer friendly version.

Name
Mailing Address
Day Phone
Evening Phone
Email Address
	I enclose a check for $240.00 made payable to "EarthWalk Vermont" (EarthWalk Vermont, a 501(c)(3) non-profit organization, is acting only as fiscal agent for the intensive)

Please print out this page and mail this form and your check to:

Kristina Bielenberg, PO Box 13, Montpelier, VT 05601.

ARCUS: National Science Foundation Office of Polar Programs through the Arctic Research Consortium of the United States - www.arcus.org

Vermont Peace Academy's Peace Education Fund

Anonymous Individuals, Ancestors, and Angels