Carl Heilman Photoshop or Photography Workshop Registration Form

Workshop Title  _____________________________________________________________

Name ________________________________   Workshop Date _______________________
                                     
Address _____________________________     
                                     
Address _____________________________   Email _______________________________
                                     
City ________________________________   Daytime Telephone (_____) ___________
                                     
State ____________  ZIP______________   Evening Telephone (_____) ___________

Emergency Contact Person - Name _____________________________________________

                        Address _____________________________________________

                          Phone _____________________________________________

Any special dietary needs(for multiple day workshops):

Please check any that apply - and any special medications for each:
__ heart problem  __ allergies   __ asthma   __ diabetes
__ other medications
			
Any other health problems or physical limitations we should know about:


A minimum deposit of $100.00 per workshop day (1 day workshop / $100., 
2 day / $200., 5 day / $500.) for each participant is due when registering.

Payment can be made by credit card or check payable to Wild Visions, Inc. 
We will confirm your reservation when we receive the registration form and deposit.

Full payment for the workshop is due 60 days before the workshop date.
If registering within 60 days of the workshop please pay the full workshop fee.
				
Program Fee 			              _____________   
Program Deposit ($100. per workshop day)      _____________
Any balance due 60 days before the workshop   _____________

Amount Enclosed (check/money order - payable to Wild Visions, Inc.)___________

You may charge __________ to my credit card:                                   
MC, VISA, Discover, American Express     |________|________|________|________|

Expiration Date   |________|   Signature  ___________________________________ 

Please send to: Wild Visions, Inc.              or register by
                6990 State Route 8             Phone/Fax (518)-494-3072
                Brant Lake, NY  12815-2229
				
CANCELLATION POLICY
For any cancellations more than 60 days before the workshop, the workshop deposit
is refundable less a $50. processing fee. 
For cancellations made 30 to 60 days before the workshop, the deposit is non-refundable.
For any cancellations made within 30 days of the workshop date, the full workshop amount
is non-refundable.

We reserve the right to cancel a workshop for low enrollment and will try to contact you
at least 30 days ahead of the workshop date and would refund any prepayment. 
Various weather conditions present interesting photographic opportunities and challenges.
We would cancel a workshop only for extreme or hazardous weather conditions.