WildWoman Registration Form

We are excited that you are registering for The WildWoman Experience 2019. This is our 4th annual WildWoman gathering. This looks to be the best year yet with a growing and thriving community of women.

Please fill out the form below and then use the PayPal button at the bottom of the page to pay your registration fee.

You must press Submit Registration and also use the PayPal buttons to pay your registration fee or you will not be properly registered.

Registrant



























Dietary Information

Our caterer offers omnivore, vegetarian and gluten free options.

Please check your food preferences:




Emergency Information

In the event of an emergency of any sort, it is our wish to responsibly provide you with support and assistance. We ask that you help us by providing the following information. We assure you that this information will be kept confidential.


In the event of an emergency of any kind, whom would we call? Please provide us with the names and telephone numbers, including cell phones, of at least two emergency contacts:


Name: Phone:


Name: Phone:

Medical Information















Terms and Conditions: You understand that you are responsible for your own safety at the WildWoman experience. There will be a release form to be signed upon arrival. Your registration fee includes a $100 non-refundable deposit. The remainder of your registration fee is refundable until one month prior to the event. After August 20, there will be no refunds for this event.

Please click the box to indicate that you have read and that you accept these terms and conditions, then click Submit Registration. After you click Submit Registration you will also need to click on the PayPal button below to pay for your registration.

Registration Fee: After you have filled out the above Registration Form and checked the box to agree to the Terms and Conditions and clicked Submit Form – then you also need to click on the PayPal link to pay your Registration Fee: