Growing Your Biointensive Skillset Registration

Please fill in a valid value for all required fields

Please ensure all values are in a proper format.

Are you sure you want to leave this form and resume later?

Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.

Save and Resume Later

Save and get link

You must upload one of the following file types for the selected field:

There was an error displaying the form. Please copy and paste the embed code again.

Apply Discount

You saved

with code

Submit Form to Ecology Action and VGFP

Submitting

Validating

There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.

Please check the field:

Fields

Growing Your Biointensive Skillset Registration

Growing Your Biointensive Skillset
runs from 9AM- 4PM each Saturday June 1 - July 27, 2024

Name*

Prefix*

First Name*

Last Name*

Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Email Address*

Telephone *

Please include area code, and country code if outside the US

This number is my*

Home Phone Work Phone Cell Phone

Other: Other Value

Please select all that apply*

I have no experience with GROW BIOINTENSIVE, but am interested in learning. I have read How To Grow More Vegetables, by John Jeavons. I have attended an Ecology Action 3-Day Workshop in Willits, CA I am currently using GROW BIOINTENSIVE growing methods.

Please tell us where and with what project and/or organization* Characters remaining:

750/750

How did you find out about this course series?*

Gender*

Female Male Prefer not to say

Other: Other Value

About You:* Characters remaining:

750/750

Please write a brief biography about yourself and why you are interested in food issues and the GROW BIOINTENSIVE method of agriculture. How do you intend to use the information you learn in this program to influence others and help your community?

What is your prime motivation for applying for this course series?* Characters remaining:

350/350

What are five specific things you would like to learn during this course series?* Characters remaining:

350/350

Please describe any farming or gardening experience you have previously had. * Characters remaining:

350/350

What do you think of hard work? Are you willing to perform demanding physical labor? * Characters remaining:

350/350

Do you have any conditions that might make certain tasks difficult for you? *

Yes No

Please describe:* Characters remaining:

350/350

How important are modern amenities for you? (Some sites are more rustic than others) Characters remaining:

350/350

How do you learn best: reading and thinking on your own, group discussion, or one-on-one discussion? * Characters remaining:

350/350

Please include a photo of yourself*

No File Chosen

File uploads may not work on some mobile devices.

Medical/Insurance Information

Because these programs can involve strenuous exercise, rustic conditions and rugged terrain, we ask that you provide some basic information regarding your health and your ability to pay for any medical care that might be required if you should sustain an injury in the course of this program.

If accepted to this program, you will be required to fill out a hard copy of our Release Form and Waiver, and to provide proof of medical insurance.

Be assured that we only use the information submitted to make sure all of our participants have the best possible experience. We will never sell or rent any of your information to anyone, for any reason.

Do you have a heart condition, back condition, or other present and/or pre-existing conditions that could limit your full participation in the physical activities of this learning program?

Yes No

If yes, please describe Characters remaining:

350/350

Please list any medications you are taking*

Date of last medical examination*

Please provide your current primary/catastrophic medical insurance coverage information

Carrier*

Policy Number*

Expiration Date*

I understand that I am responsible for covering the dedictible

I choose not to have major/catastrophic medical insurance. The results of this decision are my responsibility

Emergency Contact #1*

First Name*

Last Name*

Emergency Contact #1 Email Address*

Emergency Contact #1 Telephone Number*

Emergency Contact #2*

First Name*

Last Name*

Emergency Contact #1 Email Address*

Emergency Contact #2 Telephone Number*

Waiver: I hereby certify that I am in good physical condition and do hereby release, acquit and discharge ECOLOGY ACTION, its staff, officers and members, of any and all claims, causes of action or damages whatsoever, in any way arising out of or in any manner connected with their program or any medical treatment rendered in event of need. I understand that I am responsible for the coverage any medical expenses during my time at Ecology Action. *

I understand and agree to the terms of the waiver.

Please read carefully and select the checkbox to indicate that you understand and agree to the terms of the waiver. If you are accepted to the program, you will be required to fill out a hardcopy of our Release Form and Waiver, and provide proof of insurance. Failure to do so will prevent admittance into the program.

Email Notifications

Yes, please! No, thanks.

Would you like to receive email notifications about top-breaking local and global news and related solutions, release of new online training videos, and special workshops?

E-Newsletter

Yes, I would be interested! No, thanks.

Would you be interested in receiving an Ecology Action E-newsletter, when it becomes available?

We appreciate your interest in the work of Ecology Action. Our aim is to empower as many people as possible to feed themselves, while regenerating essential topsoil and positively addressing energy and water issues. Effective use of the Internet is a wonderful tool for advancing that goal, while remaining small as an organization.

Information that you provide in this form is for Ecology Action’s use only and will never be shared with or sold to other organizations. If you sign up for email updates or our e-newsletter, you can ask to be removed from our mailing lists at any time.

Payment

I would like to participate in the following program*

Growing Your Biointensive Skillset: Saturday June 4 - July 27, 2024, $625

Total Cost*

When you click the Submit button, below, you will be redirected to a secure PayPal payment page, where you can complete your payment arrangements. You can pay with credit card, debit card, or PayPal account.

After you click Submit, the PayPal page can take a while to load, so please be patient.
If you do not complete payment successfully, your registration will not be processed, and you will not be able to attend the course series
Please print your PayPal receipt, and bring it with you to the first class as proof of payment.

Thank you, and we look forward to seeing you in in Mendocino!

Form secured by Formstack