Student Name:

Adventure Alaska Wilderness Program Registration Form

Student's Age:

Mailing Address:

City:

Grade in School:

Phone:

e-mail:

Parent's Name:

**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.

The remaining balance is due no later than May 11.

The registration fee can be mailed to: 

Gary Leiter

PO Box 602

Soldotna, AK  99669

School Attending:

**If you have taken a class prior to this year, you cannot take the same class again to receive the second half credit.  Please e-mail me with any questions regarding this policy.

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 each class is $390

Writing Journeys

Cold Water, Land, and Small Boat Safety and Survival Course

Environmental Science I (the ultimate backpacking class!!)

**This course will be offered in place of Cold Water Safety if there is enough interest

This class is now full, but you can still sign up to be put on waiting list

This class has room for one more student

June 23--28 (if enough interest)

May 27--June 1

July 8--14