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               REGISTRATION

         Please select the workshop(s), and/or photo adventure(s) you wish to attend:

[You may select more than one workshop by simply holding down the control button and clicking on your desired choices]

Workshops & Adventures:

Please provide the following registration information:

First Name
Full Middle Name (For Alaska Bald Eagle Trip Only)
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Date of Birth (For Alaska Bald Eagle Trip Only)
Passport Number
Work Phone
Home Phone
Cell Phone
E-mail
Physical Limitations
Dietary Requirements

Payment:  

   

    Credit Card Type: 

    Credit Card Number:

    Expiration Date:  Month:      Year: 

    CCV #:  (3 digit code on the back of the card)                

    Amount To Be Billed: 

  NOTE 1: Where applicable, your deposit as part of the workshop fee guarantees your registration pending payment of the final balance as stated under the registration terms for each workshop and/or seminar.  Should you need to cancel you will receive a refund less a processing fee as stated in the registration terms for each workshop.

  NOTE 2:  By clicking on the submit button below you are indicating that you understand and agree to abide by the terms and conditions set forth in the description of each workshop, photo adventure, seminar, and class.

     Automatic Charge?
    Check here to authorize Mark Lissick/Wildlight Nature Photography to automatically charge the next applicable payment/balance to the same credit card used for the deposit payment. Charges will not be applied until the time that payment is due as indicated in the registration terms for each workshop.
   
    Check here if you would prefer to have the full workshop fee charged now.  Note: If you are registering less than 150 days  prior to a workshop we will automatically charge the full amount.
   

   
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2002-2016, Mark Lissick/Wildlight Nature Photography

Phone: (612) 804-7377      email: info@wildlightnaturephotography.com

All images on this website are protected by international and United States copyright laws and may not be copied, reproduced, stored, or used in any way without written permission by Mark Lissick.