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Location: Delaware Nature Society's Coverdale Farm Preserve

Date: Saturday, October 1, 2011 and/or Sunday October 2, 2011 (please call 302-239-2334 for Sunday availability)

Time: 1:30 pm - 4:30 pm each day

Registration Fee: $65 per person, per day

Note: Tickets are refundable until September 16, 2011


PLEASE COMPLETE THE FOLLOWING FORM FOR EACH REGISTRANT:


Registrant #1

DNS Member          Non-Member  

First Name:
Last Name:
Street Address:
City:    State:     Zip:  
E-mail: *
Phone: *    
Days Attending: Saturday        Sunday  (please call 302-239-2334 for Sunday availability)


Registrant #2

DNS Member          Non-Member  

First Name:
Last Name:
Street Address:
City:    State:     Zip:  
E-mail: *
Phone: *    
Days Attending: Saturday        Sunday  (please call 302-239-2334 for Sunday availability)


Registrant #3

DNS Member          Non-Member  

First Name:
Last Name:
Street Address:
City:    State:     Zip:  
E-mail: *
Phone: *    
Days Attending: Saturday        Sunday  (please call 302-239-2334 for Sunday availability)


Registrant #4

DNS Member          Non-Member  

First Name:
Last Name:
Street Address:
City:    State:     Zip:  
E-mail: *
Phone: *    
Days Attending: Saturday        Sunday  (please call 302-239-2334 for Sunday availability)


* = Required


Total Registrants:      Total Fees: $ 


Complimentary Childcare available during the event:

1. Child's Last Name:         First Name:         Child's D.O.B. (mm/dd/yyyy):    /    /  
2. Child's Last Name:         First Name:         Child's D.O.B. (mm/dd/yyyy):    /    /  
3. Child's Last Name:         First Name:         Child's D.O.B. (mm/dd/yyyy):    /    /  
4. Child's Last Name:         First Name:         Child's D.O.B. (mm/dd/yyyy):    /    /  


      

© 2009 Delaware Nature Society, PO Box 700, Hockessin, DE 19707 (302) 239-2334             E-mail Us!