Western Michigan University - Department of Geosciences
24th Annual Hydrogeology Field Course
Registration Form for 2012

Please fill out the form and print. Send hard copy to: Hydro Field Course, Department of Geosciences,Western Michigan University, Kalamazoo, MI 49008-5241

*Please Type or Print Clearly

University/Company : 
First Name : 
E-mail address : 
Last Name:  

Home Phone #: 

Address : 

DOB :  (month/year)

City : 
Emergency Contact (Name):   
State :  Zip : 
Emergency Contact Phone #:   
HFC 2012: July 10th - August 18th 
All weeks required for WMU Majors, Master's and Ph.D. candidates

Select the weeks you wish to sign up for:

WEEK 1 GEOS 5230 WEEK 2 GEOS 5260 WEEK 3 GEOS 5270

WEEK 4 GEOS 5250 WEEK 5 GEOS 5280 WEEK 6 GEOS 5240

Check the credit desired: Graduate  Undergraduate

I have enclosed the required, non-official, copy of my college transcript or letters of recommendation.

I have enclosed the required, non-refundable reservation deposit of $100 for each week selected. (Payable to: Western Michigan University)

__________________________________________________________________(signature) 

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