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               REGISTRATION

         Please select the workshop/photo adventure(s) you wish to attend:

[You may select more than one workshop by simply holding down the control button and clicking on your desired choices]

Workshops & Adventures: 

Please provide the following registration information:

First Name
Full Middle Name (For Alaska Bald Eagle Trip Only)
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Date of Birth (For Alaska Bald Eagle Trip Only)
Passport Number
Work Phone
Home Phone
Cell Phone
E-mail
Physical Limitations
Dietary Requirements

NANPA Membership Number (if applicable):   Expiration Date: Month:     Year: 

 

**You must be an active member in NANPA at the time of registration in order to receive your discount.**

 

Payment:  

 

    Pay by check: 

    [Your registration will be held for a maximum of seven days for your check to arrive by mail. Registration will not be final until check has cleared.]

 

    Credit Card Type: 

    Credit Card Number:

    Expiration Date:  Month:      Year: 

    Amount To Be Billed: 

  NOTE: Where applicable, your deposit as part of the workshop fee guarantees your registration pending payment of the final balance as stated under the registration terms for each workshop.  Should you need to cancel you will receive a refund less a processing fee as stated in the registration terms for each workshop.

     Automatic Charge?
    Check here to authorize Mark Lissick/Wildlight Nature Photography to automatically charge the next applicable payment/balance to the same credit card used for the deposit payment. Charges will not be applied until the time that payment is due as indicated in the registration terms for each workshop.
   
    Check here if you would prefer to have the full workshop fee charged now.  Note: If you are registering less than 120 days  prior to a workshop we will automatically charge the full course fee.
   

   
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© 2002-2007, Mark Lissick/Wildlight Nature Photography, 4501 Oak Drive, Edina, Minnesota 55424 Phone: (612) 804-7377 email: info@wildlightnaturephotography.com
All images on this website are protected by international and United States copyright laws and may not be copied, reproduced, stored, or used in any way without written permission by Mark Lissick.