Email:    
northcountryaccess@gmail.com     
   

 
 

 

 

Please complete the form fields below to register online for the event.

After June 13 & On-Site Registration:
Cost: $15.00 Individual $30.00 Family

Half Day Fishing Charter on July 14, 2012:
$25.00 Individual. ADVANCED REGISTRATION REQUIRED. Call 315.788.2730 for more information.  Please do not send payment for fishing charter until approved.

Fees Payable At Registration Table Day of The Event

View printable registration form and release form, here.

 

Full Name


Address


City / State / Zip


Home Phone*


Work Phone (Optional)


Cell Phone (Optional)


Email Address


Child or Adult?
Adult
Child

(Please Check The Appropriate Box)
 I am registering as a:

Partner
Exhibitor
Clinic Organizer
Presenter
Director
Staff
Volunteer

(Volunteers Only) T-Shirt Size:

Medium
Large
X-Large
2X-Large


Do You Have Any Specific Needs?


Activities & Interactive Clinics You Wish To Participate In And Register For:

Fishing (Requires Advanced Registration)
Sailing
Skiff Rowing
Yoga
Antique Boat Ride


If you have a partner attending with you, or you are bringing a family, please include all the names of the attendees below indicating whether they are a child or an adult.

Signature (Please Type Your Name Indicating That You Wish To Register and Will Sign and General Release of Liability Form The Day Of The Event.)