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+.

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:
*Mobile Phone: Example: 714-555-1234
*Home 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)
Orange County (closed)

San Gabriel Valley (closed)
West LA (closed)
Friends: List any leaders or friends taking WTC that you want to be grouped with.
*Sierra Club Member:

Yes
No
Member Cost: $395, Non-Member Cost: $430
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:		 Would you like to purchase the course textbook for $25?

Yes
No
*Purchase Optional Compass: Would you like to purchase the optional compass for $45?

Yes
No


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