Copy and paste this form into an email, send to EarthActivistTraining(at)gmail.com, and mail your check for deposit or full course amount with any additional information.

Name_______________________________________________________________

Address_____________________________________________________________

___________________________________________________________________

City________________________________________________________________ State/Province _______________________ Zip/Mail Code ____________________

Country, if not US ______________________

Contact Phone _______________________________________________________

Emergency Phone ___________________________________________________________________

E-mail ______________________________________________________________

(Our contact with you will be through email unless you specifically mention that this does not work for you)

Tuition for this EAT Course includes all classes, workshops, rituals, and course materials for the entire course. Lodging, transportation to and from the course, and meals are not provided.

Course Pricing: Please indicate how much you plan to pay in total, using our income-based sliding scale

______$250, if you have abundance in the form of money
______$200, if you are working and solvent
______$150, if you are scraping by
______ somewhere in between or over $150-250: $__________

Work Trade: We offer a limited amount of work trade positions per course. Work trade students are required to:

•  pay half or more, of one of the above sliding scale prices
  
•  pay a deposit (one quarter of one of the above sliding scale fees – we will not cash your check if you are not accepted for work trade, but we must have your deposit with your registration)
  
•  submit a work trade application and personal letter letting us know what your specific skills are and why you want to be considered for work trade
  
•  be willing to come early, stay late, and be assigned to one of our work trade positions

Work trade applicants are generally approved towards the end of the registration period. You will need to be flexible on your travel and be able to make last minute travel adjustments and arrangements.

______ You're applying for work-trade. If accepted, please indicate how much you could pay of your own tuition: $__________ (at least one half of one of the above sliding scale tuition prices. Your deposit will be one half of that price and must be sent in with this registration form and your personal letter).

Scholarship: Scholarship: A full EAT scholarship award (100% tuition without exchanging work hours) is very rare. We understand that many of the very people we most want in the course-activists, youth, small farmers, people from poor communities- just don't have a lot of money. So we work hard to make this training accessible to as many people as possible. Please feel free to contact us at EarthActivistTraining(at)gmail.com so we can help make this course work for you, regardless of your financial situation. If you request a full scholarship without work-trade, please mention this in your application letter, and tell us why. Otherwise we'll assume you're applying for normal work-trade.

______ Additional Donation to scholarship fund, to help others attend

(signature required—if registering by email, sign electronically by putting slash marks on either side of name.
Example: /Glitter Mudster/)

If you have any physical special needs or are differently abled, please let us know:
________________________________________________________________________
________________________________________________________________________

____ Word of mouth (please provide name of group or friend who told you about us) _________________________________________________________
____ Online at ___________________________________________ (did you click-thru the Google ad?)
____MySpace.com/earthactivisttraining?
____ Advertisement in ____________________________________
____ Flyer received at ___________________________________
____ Starhawk's book
____ Radio
____ At a talk given by________________ at location _______________
____ Online at_________________________________________________
____ Other _________________________________________________

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