Registration Form

To register online, please fill out the requested information in the form below when finished click the "Agree and Submit " button.  To complete your on line registration, you can securely pay the registration fee with a credit card via PayPal or by mailing in a check or money order.  Registration deadlines are two weeks prior to the beginning of the program.

 When using PayPal:  After submitting the form below, return to this page from the registration confirmation page, click the PayPal button at the bottom of the page and follow the instructions.  This is the only way to pay with a credit card.   

To pay by check or money order: Please fill out the requested information in the form below and then click the "Agree and Submit" button.  Your registration is not complete until payment has been received. Your full Payment must be received within two weeks of the program dates. 

If you are sending in a check or money order, make it payable to "Ancestral Knowledge" in the memo write the program name and dates and mail to the following address:

Ancestral Knowledge
PO BOX 295
Mount Rainier, MD. 20712

Help save a tree!  Please DO NOT send a copy of your registration with your payment.  We automatically receive a copy when you click the "submit" button.

For more information about registration or if you have any questions  click here. 

Please fill out the entire form below. Sign up for only one program per registration.

Program Name:   Date:

Participants Name:   Gender:  Male  Female

Date of Birth: mm/dd/yr    Age:

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Participants Name:   Gender:  Male  Female

Date of Birth: mm/dd/yr    Age:

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Participants Name:   Gender:  Male  Female

 Date of Birth: mm/dd/yr    Age:

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Address:

Home Phone: (555)555-1212

Cell Phone: (555)555-1212

Other Phone: (555)555-1212

E-mail: (adult participants only)

This section must be filled out for participants under the age of 18

Parents / Guardian Name:  

E-mail:

Address:  (If different from above)                                                           

   

Do you have any medical considerations we need to know about, especially allergies to insect bites, plants, food, or medications?

Other comments or information:

How did you hear about the Ancestral Knowledge's programs?

Emergency Contact Name (and relationship):        Emergency Contact Phone Number:

                             

Will you be paying by:      PayPal        Check or Money Order

Deposit: ($50 deposit per participant per program)

Total registration fees:   (please include the deposit)

If you will be paying via PayPal, please add an additional $5 per person to help cover some of the PayPal fees.

I would also like to donate the additional amount of to help support  Ancestral Knowledge's programs, scholarships, or land acquisition.         Programs Scholarship Fund Land Fund

Release:

I understand that I am personally responsible for my own safety and personal property while taking part in Ancestral Knowledge activities including, but not limited to, MAPS Meet, camps, and classes.   I will not hold the sponsoring parties, Ancestral Knowledge, responsible for injuries, accidents, or property damage or loss that may happen during the gathering.  I assume responsibility for risks associated with any activity that I, or any participants I am claiming guardianship for, choose to take part in.  By signing this release, I relinquish the sponsoring parties, all staff, volunteers and instructors from any claims or liability due to a personal injury, accident or property damage or loss while I, or the persons I am claiming guardianship for, are attending the Ancestral Knowledge program.  I acknowledge I am of the legal age of 18 years or older.  By signing this release I acknowledge that I have read and fully understand its contents.

Terms:

If you are mailing a check in please register online.  Full payment is due within two weeks of your registration.  Please notify us immediately if you need to cancel.  Any cancellations will be refunded minus a $25 processing fee.  No refunds will be given for cancellations after registration deadlines have passed.  All cancellations need to be given in writing by email by clicking here.

   

 For your records please print out the confirmation screen after you submit the form.

  To Pay with PayPal, You must return to this page from the confirmation page, then click the PayPal button below and follow the instructions

 

Note:  There may be problems using PayPal with the Netscape browser.  The use of Internet Explorer is recommended.  If you have any questions or problems with PayPal, contact us by clicking here.

For further information contact us at:

Phone/Fax (301) 277-1276

E-mail A.K.info@ancestralknowledge.org

Snail mail P.O. BOX 295 Mt. Rainier, Maryland 20712