Registration Thanks for your interest in our Death Valley Photography Workshop. Please fill out this form and submit payment to reserve your place in the workshop. Contact InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Mobile Phone*Email* Add me to the Batdorff Photography mailing list! Emergency Contact Name and Phone*Workshop DetailsCamera Make and Model*Workshop Goals*My goal is to provide you with a great learning experience. Please share with me some of your personal goals for this workshop.We may hike 1-3 miles on any given day. Do you have any known health restrictions that may prevent you from participating?*YesNo* If you answered "Yes" above please describe.*Comments/Questions?If you have any questions or concerns please feel free to enter in the above box.Workshop Goodies!Batdorff Photography Death Valley T-Shirt*Extra SmallSmallMediumLargeExtra Large2XLThese are American Apparel Brand T-shirts so they tend to run a little small. ACKNOWLEDGMENT AND ASSUMPTION OF POTENTIAL RISK1. Release and Indemnification: I recognize that participating in photography or other outdoor activities and related transportation involves risk of an accident and serious injury to me. I understand and acknowledge that this Activity and any related activities, by their very nature, pose the potential risk of serious injury/illness/death to individuals who participate in such activities. I understand and acknowledge that some of the injuries/illnesses which may result from participating in this Activity include, but are not limited to, the following: sprains/strains, paralysis, fractured bones, loss of eyesight, head and/or back injuries. The above list is not intended to be inclusive of all injuries that may occur, but rather to inform me of the types of risks inherent in my participation in the Activity, so that I can make a voluntary choice to participate or not participate. I also realize that the Activity may be strenuous, and that I have the option to seek the advice of a physician before I participate in this Activity. I expressly assume all risks of participating in Batdorff Photography-sponsored activities, whether those risks are known or unknown to me. I hereby voluntarily waive any claim against the Batdorff Photography, its officers, agents, servants, or employees from any liability or responsibility for any death or injuries that I might sustain which is incident to and/or associated with preparing for and/or while participating in any activity in any way connected with said Activity, including travel to and from Activity locations. I understand and acknowledge that in order to participate in this Activity; I agree to assume liability and responsibility for any and all potential risks which may be associated with participation in such activities. 2. Authorization of Medical Care: In the event I am in need of any emergency medical treatment to protect my health and welfare while participating in sponsored activities, I hereby authorize and agree to allow any authorized agent of Batdorff Photography to consent to and authorize the administering of such necessary emergency medical treatment. I acknowledge and agree that the release of liability and indemnification provisions set forth above shall apply to any authorization and consent to medical treatment made on my behalf by Batdorff Photography LLC or its authorized agents. I agree to be personally responsible for all costs of medical treatment (including emergency services) and other expenses thereby incurred. 3.I grant to Batdorff Photography LLC ("Photographer") the absolute and irrevocable right and unrestricted permission concerning any photographs that he/she has taken or may take of me or in which I may be included with others, to use, reuse, publish, and republish the photographs in whole or in part, individually or in connection with other material, in any and all media now or hereafter known, including the internet, and for any purpose whatsoever, specifically including illustration, promotion, art, editorial, advertising, and trade, without restriction as to alteration; and to use my name in connection with any use if he/she so chooses. I release and discharge Photographer from any and all claims and demands that may arise out of or in connection with the use of the photographs, including without limitation any and all claims for libel or violation of any right of publicity or privacy. This authorization and release shall also inure to the benefit of the heirs, legal representatives, licensees, and assigns of Photographer, as well as the person(s) for whom he/she took the photographs. I am a legally competent adult and have the right to contract in my own name. I have read this document and fully understand its contents. This release shall be binding upon me and my heirs, legal representatives, and assigns.Agreement* I hereby agree to the above terms and I acknowledge and understand that my participation in this class is voluntary. Payment InformationPrice*1 Person $400.00 USD (Deposit)1 Person $3200.00 (Pay In Full)2 Person $800 (Deposit)2 Person $5600.00 (Pay in full with shared room)Payment in full must be made 60 days prior to the workshop. Payment Method*Credit CardPayPalRequest for Payment PlanCredit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.