Close to Home Application  May 2012 - April 2013
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Applications for Close to Home for upcoming season are now open

You can apply for next season (2012-2013) if you'd like us to hold a place for you (max:15 people). Please use this form if you'd like to take the entire 11 trip package or the 5-trip Prairie Falcon package. Before you apply for Close to Home program, be sure to visit the Good Fit For You? page to see if this program is a match for you. If you submit application, you should receive email confirmation within 72 hours. If you do not receive confirmation, please call Cindy Spring at (510) 655-6658.

All application information is confidential. You can also use this form to sign up as an "extra" for any particular field trip. If we have room we will notify you by email if there is room.  Please indicate which trips you are interested in, or indicate you'd like to be notified about all of them. Please also submit this form if you would like to receive the monthly email notice regarding the public talk (one email per month).

PLEASE NOTE THAT YOU MUST USE INTERNET EXPLORER FOR THIS APPLICATION. FOR SOME REASON UNKNOWN TO US, IT WILL NOT FORMAT ON FIREFOX.  YOU CAN ALSO SEND APP BY MAIL TO: 3758 GRAND AVE.#38 OAKLAND, CA 94610. THANK YOU!

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Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
E-mail

Briefly describe nature activities you most enjoy


Say a few words about why you want to participate in this program, and also how you found out about it:



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Revised: 06/15/10