Registration - Northern Sierra Conservation & Wilderness Medicine Conference

Registration Form

September 8 - 10, 2023
Quincy, California

Complete the registration form below to secure your workshop and lodging selections.

You are Registered as a

Event	Options

^* Required

First Name ^*

Please confirm your First Name

Last Name ^*

Please confirm your Last Name

Email Address ^*

Please confirm your Email Address

Home Phone

Cell Phone ^*

Please confirm your Cell Phone Number

Billing Address ^*

Please confirm your Billing Address

City ^*

Please confirm your City

State ^*

Please confirm your State

Zip Code ^*

Please confirm your Zip Code

Country

List Dietary Restrictions

Company/School

Medical Specialty (if applicable)

Other Related Affiliations (i.e. organizations, associations, universities, etc.)

Outdoor Interests (i.e. hiking, skiing, mountain biking, etc.)

Select Your Accommodations ^*

Gender separate dormitory style cabin

I will be camping at the conference venue (Capacity Reached)

I will arrange my own accommodations for the weekend

Cancelation Policy Agreement

Please Read Cancelation Policy Before Agreeing.*

Cancelation Agreement: Cancelations received in writing more than four weeks prior to event will receive a full refund minus a refund processing fee. Cancelations received in writing two to four weeks prior will receive a refund minus a $100.00 administrative fee. There will be no refunds for cancelations received within two weeks of the event. Please remember that canceling your registration does not automatically cancel your hotel and travel arrangements. Individuals are responsible for canceling their own hotel and travel reservations.

Please remember that canceling your registration does not automatically cancel your hotel and travel arrangements. Individuals are responsible for canceling their own hotel and travel reservations.

I have read and agree to the terms above. ^*