Discover Virginia Registration Form

To register for the Discover Virginia: A Natural History Retreat online, please complete and submit the form below.

Event
	Full Registration - $115
	Discount Rate for Silver Explorer members and above and educator - $105
	Saturday Only Registration Discover Virginia - $75
	Sunday Only Registration Discover Virginia - $75
	Saturday Box Lunch - $7
	Sunday Box Lunch - $7
	Saturday Vegetarian Box Lunch - $7
	Sunday Vegetarian Box Lunch - $7

Name*

Address*

City, State, Zip*
Home Phone
Office Phone
E-mail Address*

How did you hear about the the event?
Number of years attended?
Wintergreen Community Member	Yes No

The Wintergreen Nature Foundation
R.R 1, Box 770
Roseland, VA 22967