2012 Wyoming-Montana Online Application

Wyoming & Montana / 12 Day Adventure / July 8-19, 2012 Online Application

Enrollment Update: We just had a cancellation, so as of today we have one opening. Email us for additional updates or use this form to save this spot. And of course we're already enrolling for the 2013 adventures with nearly two dozen boys already signed up.

To apply online, open and read the online downloadable and printable application by clicking here. Then complete the form below and submit. You'll either need to mail in your deposit check or you can pay with credit & debit cards by clicking the link at the bottom of the page. Questions or comments, email me at marklevin@windstream.net or use the contact page form.

Name of Participant *

First

Last

Birthdate of Participant *

School attending? *

Grade in school? *

Name of Parents *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

I have read the notes and the complete Wyoming & Montana trip application and have an understanding about how this trip will function. I want my child to participate in this tour. I agree to hold Mark Levin and all additional leaders harmless for all claims arising out of this trip. My child agrees to abide by codes of conduct as set by the leaders. *

Yes, I've read everything and I/we agree.

How did hear about MindStretch Travel Adventures? *

Why does your son want to go with us? *

Names and addresses of friends who might be interested in coming with your son. *

Do you have any questions or comments? *

Submit

Pay your deposit online.

Use the Pay Now button below to pay your $100 non-refundable deposit online. Or you can just mail a check to me at my address on the contact me page.