High Desert Chapter, Native Plant Society of Oregon
2010 ANNUAL MEETING REGISTRATION FORM
May 14-16, 2010, OMSI Hancock Station, Clarno, Wheeler County, OR
Please register by Friday, April 16, 2010 (postmarked). No refund after April 23.
Name(s) ________________________________________________________________________________________
Address ________________________________________________________________________________________
City, State ________________________________________ Zip_____________________ Phone _________________
Chapter _______________________________________ E-mail ____________________________________________
Hancock: dormitory cabin accommodations ____ people @ $ 50.00/night x ______ nights = $____________
(mattress supplied; bring sleeping bag and towel and shower supplies)
Cabin size preference: sleeps 2 ___ , 4 ____, 6 ____, or 10 ____ . Names of cabin mates:
____________________________________________________________________________________________________________
Hancock: tent (max. 10 spaces)_____ or RV (max. 10 spaces)_____ $ 50.00/night x ______ nights = $___________
Self-contained (no hookups)
NOTE:
For those choosing to stay outside the Hancock Station (motel/hotel/B&B, campground, or elsewhere), feel free to sign up for meals at Hancock if you wish to do so.___________________________________________________
Friday Evening Social (finger food) ____people @ $5.00 = $________
Saturday Breakfast ____people @ $10.00 = $_________
Saturday Sack Lunch (sandwich, fruit, cookies) _____people @ $5.00 = $_________
Indicate one choice per person: Vegetarian _______ Meat _______ Special dietary needs (please specify; Hancock will try to accommodate) _____________________________________________________________
Saturday Banquet ____people @ $10.00 = $__________
Indicate one choice per person: Vegetarian ________ Chicken________ . Special dietary needs (please specify; Hancock will try to accommodate)_______________________________________________________
_________________________________________________________________________________________
Sunday Breakfast ____people @ $10.00 = $__________
Sunday Lunch ____people @ $10.00 = $__________
________________________________________________________________________________________________
Field Trip Preference: Saturday field trips are briefly described in the Bulletin. More information may be found on the NPSO state website: http://www.NPSOregon.org. Please select 3 trips and number 1 to 3 with 1 as your top choice. If more than one person is using this form, each person should initial their numbered preference.
_____Painted Hills
_____Hancock Field Station Hike
_____Lawrence Memorial Grassland Preserve
_____Spring Basin Wilderness Area
_____Paleontology/Geology
_____Warm Springs Confederated Tribe – Pine Creek Ranch
Make checks payable to: High Desert Chapter, NPSO
Send check and this form to Paul MacMillan, 3485 NW Braid Drive, Bend, OR 97701.
Please include a self-addressed stamped envelope for confirmation and map.
Please sign the waiver (on the reverse side of this form), and return it along with your registration.
Questions? Email Berta Youtie at byoutie@crestviewcable.com or Paul MacMillan at pmac3485@bendbroadband.com.
(Before returning this form, please photocopy for your own records.
Native Plant Society of Oregon
Waiver of Liability
Indemnification Agreement
*** Please Read All of This Form. It is Important!***
Thank you very much for coming on a NPSO field trip! The following agreement is necessary for the well-being of NPSO and all field trip participants. We appreciate your understanding.
I understand that I am solely responsible for my own safety at all times. I acknowledge that my participation in any Native Plant Society of Oregon (NPSO) field trip is purely voluntary, and I understand that some parts of the field trips may be hazardous and may result in the damage or loss of my property or in my injury.
I agree to take full responsibility for my own medical needs. I am aware that trips require physical outdoor activity and have certain risks inherent with exposure to nature and natural processes. I certify that I have no health or physical problems which would interfere with my participation.
I understand that horseplay, roughhousing, shoving, contact sports, or other such activities are not appropriate and not allowed on NPSO trips.
I agree to stay with the group. If I need to vary for any reason, I will do so only with the permission of the leader.
I understand that transportation to the beginning of the trailhead or field site is not part of any NPSO-sponsored activity. Although NPSO suggests carpooling to save gas and reduce pollution, I agree that if I carpool, it is an independent activity organized by myself and other individuals on our own initiative and at our own risk.
I hereby agree for myself and for my heirs, representatives, agents anad assigns, that I will not hold the NPSO liable. I will waive and release any claims, demands or actions against them, for any damages to or loss of my property, or for my illness, injury or death, which results from or arises in connection with any NPSO field trip other than that which results from gross negligence.
The persons and organizations covered by this agreement are:
NPSO, its officers or members, and
Any other participant(s) in field trips including any people invited by any NPSO member(s) and
Any of the agents or employees of the above persons and organization.
In addition, I agree to indemnify the above people for any claims made against them on my behalf or otherwise, as a result of any damage to or loss of my property, or as a result of my injury or death, resulting from or arising in connection with the NPSO field trips, other than that which occurs as a result of the gross negligence of that person(s).
I HAVE READ THIS ENTIRE FORM, AND AGREE:
_______________________________ _______________________________ _____________________
Printed Name Signature Date
_______________________________ _______________________________ _____________________
Printed Name Signature Date
