The Naturalist Journey Bird Language Retreat

11-14 April, Gilwell Park, Gembrook.

Please fill in this short registration by April 3rd at the latest.

Please note that all information will be kept private and confidential.

Personal Details

Name

First Name

Last Name

What is your phone number?

Do you have specific dietary requirements?

Are you under the care of a medical professional for a current condition?

Yes

If yes, please explain.

Are you currently taking any medications?

Yes

If Yes, please list medication and condition

List any allergies (including to medications)?

What is your emergency contact name and number?

How did you find out about this event?

Tell us a little about what drew you to this event? (Optional)

The Naturalist Journey Bird Language Retreat Registration Form