REGISTRATION FORM

Print this form and mail it with your non-refundable deposit (see schedule for amount) to the address below.

Please include a brief letter of intention describing what it is that calls you to undertake this journey at this time.Send to:
Anne Stine
Wilderness Rites
480 Herbert St
Ashland, Oregon 97520

Please read carefully the program requirements before you register.

Trip Title:
Date:
Name:
Address:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Fax:
Email:
Occupation:
Age:
Previous Camping Experience:

WILDERNESS RITES, LLC

Anne Stine
541-488-4899
480 Herbert St, Ashland, OR 97520
astine@wildernessrites.com