Email:    
northcountryaccess2010@gmail.com     
   

 
 

 
 

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

After June 18 & On-Site Registration:
Cost: $15.00 Individual $30.00 Family

Half Day Fishing Charter on July 17, 2010:
$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:
 a
 Opening Session, Dr. Jon Kuniholm, Fri. July 16th:  9:30 - 10:30
 Kayaking
 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.)