Download Jepson Herbarium 2013 Workshop Registration Form

Jepson Herbarium 2013 Workshop Registration Form
Please print legibly or type into the form after saving it to your
computer. Use one form for each participant. Mail your completed
registration form with payment to:
Jepson Herbarium Workshops
1001 VLSB #2465
Berkeley, CA 94720-2465
PLEASE NOTE:
For security reasons, we
do not accept registration
forms by fax or email.
Course prices are listed as Jepson Friend /General Public. Are you a current
member of the Friends of the Jepson Herbarium ?
Yes
No
Basic Botany workshops are marked with “BB.”
Please check the boxes to indicate your registration requests:
Arctostaphylos • Jan 25-27 $360/$400
Insect Herbivores • May 11 $115/$155
Polemoniaceae • May 31-Jun 2
$325/$365
Participant Information
BB: Mastering The Jepson Manual
Mar 2 $80/$120
Aug 17 $80/$120
Name:
BB: Bryophytes • Feb 23-24 $150/$190
Address:
Seaweeds: Details & Data • Mar 16
$115/$155
City: State & Zip:
BB: Intro. CA Plant Families • Jun 8-9
WAIT LIST
Monkeyflowers in Flux • Jun 13-16
$425/$465
Anza-Borrego • Mar 21-24 WAIT LIST
Grasses of the Chiricahua Mtns. Sep
5-8 • $575/$615
BB: Intro.Plant Morph.• Mar 30-31
$150/$190
Trees of the Smoky Mountains
Sep 19-22 • $775/$815
Preferred Phone:
Please check one: Cell
Work
Home
Alternate Phone:
Please check one: Cell
BB: 50 Families (Berkeley) • Apr 4-7
WAIT LIST
Forest Diseases
$200/$240
Work
Home
Exploring Tejon Ranch • Apr 18-21
WAIT LIST
Amphibians and Reptiles • Nov 16-17
$200/$240
e-mail address:
Please list any dietary restrictions or special needs we should be
aware of:
Emergency Contact Information
Name:
Relationship:
Phone number:
I have read and understand the cancellation policy online at:
http://ucjeps.berkeley.edu/workshops/2013/regform_2013.html
•
Oct
26-27
BB: 50 Families (Hastings)•Apr 25-28
$460/$500
Botany & Big Horn Sheep•Apr 25-28
$475/$515
We appreciate full payment if you are registering for a workshop that is less
than 60 days away. Checks are our preferred method of payment. Please
make your check payable to UC Regents, or pay by Visa or Mastercard:
Account Number:
Expiration Date:
Amount Enclosed:
Signature:
Billing address (if different from address at left):
How did you find out about our program?
Notes: