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Wild at Heart BASIC Registration
Aug 12-15, 2021 (Woodlands Lodge, Cleveland GA)
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First Name
*
Your answer
Last Name
*
Your answer
Street Address
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
Your answer
Phone Number
*
Your answer
E-mail Address
*
Your answer
Have you ever attended a Wild at Heart BASIC or Boot Camp?
*
Yes
No
Dietary Restrictions (if none, leave blank)
Your answer
Roommate Request (if none, leave blank)
Your answer
Amount Paying Upon Registration
*
$100 Deposit
$250 Full Registration
Payment Method (please send payment to one of the below usernames)
*
Venmo (@Jacob-Dowling)
PayPal (@jddutk)
Apple Pay (404-313-5060)
CashApp ($jddutk)
Other (if you prefer to pay by check, please e-mail
jacob.d.dowling@delta.com
)
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