Education Form – Youth Explorer Series - Northern Michigan Land Trust

Pick Your Summer Program(s)**
- Select All
- Birding - June 30
- Wilderness Survival Skills - July 14
- Mountain Biking Adventure - July 21
- Kayaking Round Lake - July 28
- Hike the Pigeon - August 4
You can select as many programs as you would like to register for.
Parent Name*
First Last
Child / Children's Names and Birthdays*

Please list the name of each child attending the chosen program or programs along with their full birth date. Ex: Sam Smith 5/1/2007, John Smith 5/2/2009
Parent Contact Email*
Parent Contact Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Are you a current LTC Member?*
- Yes
- No
Education Programs are free to current members. $5.00 for non-members. Please call our office (231) 347-0991 if you are unsure of your membership status.
Become a Member
Total Programs*
Price: $5.00
Please multiply the number of programs you selected by the number of children attending the programs. Ex. 2 children attending 2 programs would be 4 Total Programs.
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Important information that our teachers should know
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