Student Name:

2012 Adventure Alaska

Registration Form

Student's Age:

Mailing Address:

City:

Grade in School:

Phone:

Parent's e-mail:

Parent's Name:

The remaining balance is due no later than May 11.

The registration fee can be mailed to: 

Adventure Alaska/Gary Leiter

PO Box 602

Soldotna, AK  99669

-or-

dropped off at Cook Inlet Academy on K-Beach Rd

Student's email:

Questions?  Please write them in the space below.  They will be submitted to me along with your registration.

No refunds will be given after April 25.  Classes will fill up so don't wait until the last minute to pay your deposit.

Cost for the class is $395

**Important:  Submission of this reservation form will reserve a place in the class for up to 7 days.  If the $100 registration fee is not paid within this 7 day period, the reservation will be cancelled.

June 27-July 2

May 21-Aug 4

Cost for the class is $300

Backpacking Class         Online Writing Class