Lifelong Learners

Instructions

Method 1:  Fill in and submit this online form, then mail your check or money order within the next 7 days to the address below.
IMPORTANT NOTE: Questions marked with a red asterisk (*) are required. Incomplete forms will not be submitted.

Method 2:  Print and fill out this form, then mail in with your check or money order to the address below.

Mail to:
Scheduling Coordinator
NC Museum of Natural Sciences
11 West Jones Street
Raleigh, NC 27601-1029

Make checks payable to Museum Extension FundPlease write program name on check.

Cancellation Policy: If the Museum cancels the program, the registrant will have the option of receiving (1) a credit toward a future Lifelong field program, or (2) a full refund*.  If the registrant cancels their registration 7 days or more prior to the departure date, then a refund* or credit, less a $25 processing fee, will be given.  No refund or credit for reservations canceled by the registrant less than 7 days before the departure date.
*Registrants must submit a W9 form to receive a refund.

Questions?

If you have questions, please contact Jerry Reynolds at 919.707.9884 or jerry.reynolds@naturalsciences.org.

Fields marked with an * are required

Mailing Address

Apartment, Unit, Etc.

Friends of the Museum membership number without any hyphens.


Program Information


Health Information

Please list allergies, dietary restrictions or other health conditions, such as diabetes, epilepsy, abnormal blood pressure, etc., that we should be aware of during your participation in this field experience.

Please list medications or medical equipment you will carry on this field experience to treat onset of a medical situation, such as an EpiPen for severe allergic reactions or an inhaler for asthma attacks.

Emergency Information


Notice of Dangers

Primary dangers on field experiences may include falling on rocky, muddy or slippery terrain, twisting an ankle on uneven terrain, being scratched by thorns, animal bites or stings, drowning when on or near water, hyperthermia in hot weather, hypothermia and frostbite in cold weather, and physical trauma in a vehicular accident. Most dangers can be avoided by following directions of trip leaders and being observant and careful in the field.

I have read and understood the information provided for the field experience and I am fully aware and accept the risks involved. I have informed the trip leaders of any health issues that may affect my ability to participate on the field experience. I have health insurance and am carrying my health insurance card with me.

If you do not receive a confirmation email immediately following the submission of this form, please call 919.707.8860.


 

Snow Geese at sunset. Photo: Melissa Dowland/NCMNS.