2012 COURSE DATES: AUGUST 4 – 17, 2012 - Sirenian International

Ecology, Behavior & Conservation of Manatees and Dolphins
A Unique Field Course in the Drowned Cayes, Belize
Session III: August 4-17 2012
Step 1: PRINT & COMPLETE THIS FORM - ALL PRICES ARE IN $US
Step 2: Mail, Fax, or Scan & Email the SIGNED registration, syllabus, transcripts & policy forms
Step 3: I will send you and invoice, which you can pay online or by mail
Mailing Address, Email Address, and Fax:
Caryn Self-Sullivan, 200 Stonewall Drive, Fredericksburg, VA 22401-2110
Phone: 540.287.8207 | Fax: 888.371.4998 (Country Code 001)
Email: Caryn Self-Sullivan (cselfsullivan@sirenian.org)
Name:
Mailing Address:
City, State, Postal Code, Country:
Email Address(es):
Cell & Home Phone #s:
(cell) (home)
Why do you want to participate in this course? You do NOT need to be currently enrolled in school, however describe your academic status & highest
degree. Don't forget to send unofficial copies of your transcripts and answer questions on page 2:
Openings available only in Session III Fee
Session I: 26 May - 8 June 2012 $2,995
Session II: 16 June - 29 June 2012 $2,995
Session III: August 4-17 2012 $2,995
Note: If you register for more than one session, you will be responsible for expenses b/t sessions!
Total Cost (excludes airfare, credit hours & tips)
DEPOSIT (Minimum $500) Due now; I will invoice you upon receipt of registration!
Low-income Country Scholarship* $500
Early Registration & Recruiting Discounts* (Max $100)
Late Payment / Late Registration Fee $100
Balance due at least 60 days prior to fielding
* Attach a 1500 word essay describing how this opportunity will enhance both your personal career goals AND
sirenian research, educational outreach, and conservation in your home country
** $100 discount if you register and submit $500 deposit by February 1st; $25 discount each for you and a friend, for
each friend you recruit, provided you and your friend(s) register and submit $500 deposit by March 1st; $25 discount if
you register and pay in full by March 1st ; Mix and Match discounts for up to a maximum total discount of $100.
By signing below, I hereby promise to pay the price indicated above subject to qualified discounts
and the refund policy as stated in the Syllabus. I understand that I will be invoiced for the deposit
immediately, and balance is due at least 60 days prior to fielding. Invoices will be sent via PayPal
from "MIB: Research & Educational Expeditions." A $100 fee will be assessed for returned checks
or chargebacks.
Signature ____________________________________________________________________
Comments or Questions: