Wild at Heart BASIC Registration

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August 17-20, 2023 (Whitewater Express, Copperhill TN)

First Name *

Last Name *

Street Address

City *

State *

Zip Code

Phone Number *

E-mail Address *

Have you ever attended a Wild at Heart BASIC or Boot Camp? *

Yes

Dietary Restrictions (if none, leave blank)

Roommate Request (if none, leave blank)

One adventure activity is included in the registration fee. Which would you be most interested in joining?. *

Whitewater Rafting on the Middle Ocoee River

Horseback Riding

Paintball

I'm not interested in any of these

Amount Paying Upon Registration *

$100 Deposit

$225 Full Registration

Payment Method (please send payment to one of the below usernames) *

Venmo (@Jacob-Dowling)

PayPal (@jddutk)

Apple Pay (404-313-5060)

CashApp ($jddutk)

Other (if you prefer to pay by check, please e-mail jacob.d.dowling@delta.com)

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