Bioregionalist Activist Gathering

Registration Form

Please submit payment at time of registration.

If payment is not received within 5 days of registration (12 days for check by mail), your form will be discarded and you will need to resubmit.

Name *
Title *
Organization
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Phone
### - ### - ####
Web Site
Birthdate
Have you already submitted your payment?
If so, how did you submit that payment?
How many people did you include in that payment?
Was your payment submitted under a name other than the name you provided on the form? If so - include that name here:
Let us know if you have any special dietary needs (ie..vegan, gluten free, food allergies).
How will you be arriving at the event?
Are you physically able to camp & walk around a wilderness site with no sidewalks or pavement?
Select your intended sleeping arrangement:
If you selected "vehicle" in the previous question - please describe your vehicle to us.
If you selected "camping" as a sleeping arrangement, select any (or all) of the following options as your desired location:
Are you interested in applying for one of our limited work trade positions?
If you selected "yes" for the work trade, tell us what area of work trade you are interested in helping in, and provide any pertinent experience you would lend to this position. We need trade in the following areas: kitchen, childcare, take down, logistics.
Read the "Registration Information Document". After reading the document thoroughly, confirm that you understand the entirety of its contents and agree to it by typing your full name here: