Registration | Refuge Foundation

Please don’t register until you have your Airline tickets. Email info@refugefoundation.org with any additional questions.

ABOUT YOU

First Name

Last Name

TRIP INFO

Refuge Trip Start Date

Flight Arrival Date and Time

Flight Departure Date and Time

ORGANIZATION INFO

Name of Your Organization

Street Address

Street Address 2

City

State / Province

Postal / Zip Code

Phone Number (include area code)

PERSONAL INFO

Street Address

Street Address 2

City

State / Province

Postal / Zip Code

Cellphone Number (Include area code — this needs to be the phone you will carry during your time at the Refuge Foundation)

MORE INFO

Emergency Contact Name

Emergency Contact Phone Number (include area code)

Do you need Refuge to provide you with a rod and reel?

YesNo

Do you need Refuge to provide you with waders / boots?

YesNo

Shirt Size

If yes, Shoe Size?

Any food restrictions we need to know of?

Any special needs we need to be aware of?

Comments

LIABILITY WAIVER

By checking yes below and clicking Register, I hereby release the Refuge Foundation and its officers and employees from any liability of personal injury, or loss or damage to personal property during activities associated and/or participated in while on my Refuge Foundation Adventure.

I acknowledge that I understand the waiver described above. Waiver is made to the maximum extent permissible under applicable law. I acknowledge that I have agreed to this under my own free will.

YesNo