Ralph Nordstrom Photography Presents
2013 WORKSHOPS
© 2008-2013 by Ralph Nordstrom
Workshop Registration Form
Fax Both Pages to (949) 589-8457 or mail to address below
Don’t forget to also fax the signed Assumption of Risk form
Please print clearly and fill out as completely as possible:
Check the workshop(s) you are registering for:

Death Valley, California
Feb 9-12, 2013

Death Valley II
Feb 12-15, 2013

Redwoods, California
May 29-June 1, 2013

Big Sur Summer, California
Aug 5-8, 2013

Zion, Utah
Oct 12-15, 2013

Bryce Canyon, Utah
Oct 15-18, 2013

Utah Super Workshop
Oct 12-18, 2013

Big Sur Winter, California
Nov 4-7, 2013
4 days, 3 nights
4 days, 3 nights
4 days, 3 nights
4 days, 4 nights
4 days, 3 nights
4 days, 3 nights
Zion & Bryce together – 7 days, 6 nights
4 days, 4 nights
Name
Address
City
State
Home Phone
Cell Phone
Email
Zip Code
Age
Emergency Contact (name, relationship and phone)
Please note that if you are under the age of 18, you must be accompanied by an adult or a legal guardian.
All forms must be signed by an adult or a legal guardian.
Health Information
Travel Information
 Air: Arrival airport
 Driving: Vehicle
Photographic background
Type of Camera Equipment used:
 Large or Medium Format
 35mm SLR
 Digital SLR
 Digital Point and Shoot
I consider my skills to be at the following level
 Novice
 Amateur
 Advanced
 Professional
Other workshops attended
Other special considerations
$545 USD
$545 USD
$545 YSD
$545 USD
$545 USD
$545 USD
$975 USD
$545 USD
Payment Method
Check
Make checks payable to Ralph Nordstrom Photography
Check # ____________
Mail check to the address below
Credit Card:
 VISA
MasterCard
 American Express
 Discover
Credit Card Number
Security Code:
________ ________ ________ ________
Expiration Date __________/__________
___________ (the 3 digit number on the back of your Visa or MasterCard, the 4 digit number on the front of your Amex)
Coupon code: _________________________
Payment amount:  $200 deposit
 Payment in full (if registering fewer than 30 days before the workshop)
With this signed registration form you have acknowledged that you do not have any physical conditions that could put yourself in danger. You also
acknowledge you have read and agree to the cancelation policy below. Please note that Ralph Nordstrom Photography is not responsible for any special
dietary needs.
Signature
Date
Deposit and Payment Information
 Please return your Deposit, Registration Form, and Assumption of Risk Document as soon as possible.
 A $200.00 non-refundable deposit is required for each individual workshop. If registering fewer than 30 days
before the workshop, full payment is due.
 Available discounts (sorry, only one applies):
o
o
o
o
10% early bird if sign up by 12/31/2012
10% NANPA discount
15% alumni discount
33% bring a friend discount
 Some workshops have limited space. First come first served.
 CANCELLATION POLICY: The $200 deposit is non-refundable. Final payment is due 30 days prior to the
beginning of each workshop. If you cancel more than 15 days before the workshop all paid fees will be refunded
except the $200 non-refundable deposit. If you cancel 15 or fewer days from the workshop the paid fees cannot
be refunded.
 Please fax, email or mail your reservation forms to Ralph Nordstrom Photography. See contact information
below. DO NOT email your credit card information.
 Have questions; need more information: Contact us
Return this form with the deposit and the signed assumption of risk form to…
Ralph Nordstrom
Ralph Nordstrom Photography
25422 Trabuco Rd Ste 105/250
Lake Forest, CA 92630
Ralph@RalphNordstromPhotography.com
(949) 589-0958
(949) 589-8457 Fax