Registration Form Session 3 ~ Sept 1-4, 2023

When

Friday, Sept. 1, 2023 at 12:00 PM PDT
-to-
Monday, Sept. 4, 2023 at 4:00 PM PDT

Where

Black Oak Ranch
50350 Hwy 101
Laytonville, CA 95454

Contact

Terri Tall Tree & Gwen River Song
ncwhs@monitor.net
707-824-1429

Download the Work Exchange Application

Download the Scholarship Application

33nd Annual
Northern California Women's Herbal Symposium
ncwhs@monitor.net 707-824-1429

Session 3: September 1-4, 2023

Welcome!

Scholarship spaces are full, waitlist only.

Session 3, 2023

*Required Information

First Name

Last Name

Confirm Email

Phone/Mobile

Address

City

State

Zip Code

Meal Choice

Regular Vegetarian

Vegan

Gluten Free

Vegan & Gluten Free

Is it ok to include you on the roster?

Yes

Interested in carpooling?
Check out the Ride Sharing link under the "general Info" button on the website.

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Please fill out a separate registration form for each additional adult.

If you are a teacher, staff or trade do not select a fee. Enter your code at checkout.

I will choose one of the following for the adult listed above unless I am a TEACHER, STAFF OR TRADE

yes

REGULAR sliding scale 1

Fee: $490.00

Quantity

REGULAR sliding scale 2

Fee: $525.00

Quantity

REGULAR sliding scale 3

Fee: $560.00

Quantity

REGULAR sliding scale 4

Fee: $600.00

Quantity

CRONE discount age 60+, if needed sliding scale 1

Fee: $350.00

Quantity

CRONE discount age 60+, if needed sliding scale 2

Fee: $400.00

Quantity

Work Exchange~APPLICATION REQUIRED

Fee: $150.00

Quantity

Scholarship~APPLICATION REQUIRED, full ~ waitlist only

$0.00

Quantity ~ add to waitlist

Woman of Color Scholarship, full ~ waitlist only

$0.00

Quantity ~ add to waitlist

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Do you plan to sell at the marketplace, your own handmade goods only? By donation, suggested donation 10% of sales.

yes

List all marketplace items for sale, registrants own handmade goods only.

________________________________________________________________________

Registering children or young women to attend with you?

Yes

In this section, please list the details for each additional child or young woman in your group.

Add One

yes

First Name

Last Name of Responsible Adult

Age of child or young woman

Meal Choice

Regular Vegetarian

Vegan

Gluten Free

Vegan & Gluten Free

Add A Second

yes

First Name

Last Name of Responsible Adult

Age of child or young woman

Meal Choice

Regular Vegetarian

Vegan

Gluten Free

Vegan & Gluten Free

Add A Third

yes

First Name

Last Name of Responsible Adult

Age of child or young woman

Meal Choice

Regular Vegetarian

Vegan

Gluten Free

Vegan & Gluten Free

Add A Fourth

yes

First Name

Last Name of Responsible Adult

Age of child or young woman

Meal Choice

Regular Vegetarian

Vegan

Gluten Free

Vegan & Gluten Free

Add A Fifth

yes

First Name

Last Name of Responsible Adult

Age of child or young woman

Meal Choice

Regular Vegetarian

Vegan

Gluten Free

Vegan & Gluten Free

Add A Sixth

yes

First Name

Last Name of Responsible Adult

Age of child or young woman

Meal Choice

Regular Vegetarian

Vegan

Gluten Free

Vegan & Gluten Free

Add A Seventh

yes

First Name

Last Name of Responsible Adult

Age of child or young woman

Meal Choice

Regular Vegetarian

Vegan

Gluten Free

Vegan & Gluten Free

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Fees for young women and children

I will choose from the options below for the children and/or young women I have added.

yes

Young Woman age 12-21, sliding scale 1

Fee: $180.00

Quantity

Young Woman age 12-21, sliding scale 2

Fee: $200.00

Quantity

Child age 3-11 years sliding scale 1

Fee: $60.00

Quantity

Child age 3-11 years, sliding scale 2

Fee: $80.00

Quantity

Child age 3-11 years sliding scale 3

Fee: $100.00

Quantity

Infant, age 0-2 years, no fee

Fee: $0.00

Quantity

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Proceedings of The Conference

This is our womyn's herbal words. This is a collection of hand-outs and articles from the classes of this session, bound together in a soft cover spiral-back book. Pick up your pre-ordered book when you check in on the first day. They will also be available for sale there for $25.00

Proceedings

Fee: $20.00

Quantity

________________________________________________________________________

No payment items has been selected yet

Checkout

Check or Money Order within 5 days

Credit Card

I have a code

Scholarship Waitlist

Make check payable to:
NCWHS
PO Box 28
Graton, CA 95444

Be sure to fill in and apply code to receive full discount

Apply Code

Select 1

Teacher

Staff

Trade

Enter your total to calculate the credit card fee

Enter your total here

Credit Card Fee

Pay with Credit Card

Refresh the page to register additional adults