Complete Application (Step 2 of 3)

Step #1
Review Course Info		 Step #2
Fill Out Application		 Step #3
Pay Course Fee

Step #2 Instructions: Please fill out the application below. Required fields are noted with an asterisk (*). After you have completed the application, click the submit button. This form is best completed using FireFox 2+ or Internet Explorer 7+.  If you wish to pay by check, please fill out our registration form and mail it in.

Your private information will not be shared or used outside of WTC.

Very important: Your enrollment in class is not confirmed until payment is complete!  Be sure to go all the way through the payment process until you arrive back at the WTC site.
*First Name:
*Last Name:
*Street Address: Include Apartment #
*City: No Need To Enter State (CA)
*ZIP Code:
*Email:
*Night Phone: Example: 714-555-1234
*Day Phone: Example: 714-555-1234
How did you hear about the WTC?
*Age: The minimum age is 14. Anyone under the age of 18 must be accompanied by a parent or legal guardian during the entire course.
*Gender:

Male
Female
*Course Location:

Long Beach/South Bay (closed)
Contact Joan Rosenburg for waitlist info
Orange County (closed)
Contact Wendy Miller for waitlist info

San Gabriel Valley (closed)
Contact Jim Martens for waitlist info
West LA (closed)
Contact Danielle Zucker for waitlist info
Friends: List any leaders or friends taking WTC that you want to be grouped with.
*Sierra Club Member:

Yes
No
Member Cost: $335, Non-Member Cost: $360
Sierra Club Membership#: If you are a Sierra Club member enter your membership number here. If you recently joined the Sierra Club and do not yet have a membership number, enter the approximate date that you joined.
*Purchase
Textbook:

Yes
No
Would you like to purchase the course textbook for $20?
*Purchase Optional Compass:

Yes
No
Would you like to purchase the optional compass for $40?