On-line Registration Form

If you would prefer to complete a printed application, please Click Here and print form.


Instructions: You may use this on-line Registration Form to Apply to the La Suerte or Ometepe Biological Field Stations. Before you complete this form, you should make yourself familiar with all of the information contained on this website. In particular, you should Read, Print, and Retain all
important documents: Click Here For Links To All Important Documents

Please complete all of the fields below. Once you send the form we can begin preliminary processing of your application, however, we will not be able to fully process your application until you forward the items listed below.

Within several days of completing the on-line registration form, you will hear from us by email and will be placed on a class roster. Please check your emails regularly during the enrollment process. All enrollments will be coordinated electronically from our Miami Office.


Please note:
By completing and submitting this form, you are making an official, formal application to this program. Make sure you have read the important information above.
Application Date:
Proposed Enrollment Date:
U.S./Canadian Social Security # if Applicable:
First Name:
Middle Name:
Last Name:
Current Address - Street:
City:
State:
Zip:
Country:
Dates when at this address:
Current Phone:
Current E-mail:
Permanent Address - Street:
City:
State:
Zip:
Country:
Dates when at this address:
Permanent Phone:
Permanent E-mail:
Birth Date:
Citizenship and Place of Birth:
Passport Number:
Place Issued:
Height:
Weight:
Marital Status:
Sex:
Please detail any physical or
medical dietary requirements:
College Graduation Date:
Academic Status:
College Name:
Department:
Major (actual or intended):
   
Short Term Classes
  Course Name Field Station Location / Date
Primate Survey & Assessment
– Bioblitz
Ometepe — June 22 to July 6
Neotropical Ethnobotany La Suerte — July 20 to Aug 2
Primate Behavior & Ecology La Suerte — July 20 to Aug 2
Mixed Media Art Workshop
in the Rainforest
La Suerte — July 20 to Aug 1
Photographic Workshop
in the Neotropics
Ometepe & La Suerte — Aug 1 to Aug 14—$1850

Primate Behavior & Ecology

Ometepe — Dec 27 to Jan 8

Comparative Skeletal Anatomy
& Function
Ometepe — Dec 27 to Jan 8
Advanced Primate Behavior
& Ecology
La Suerte — Dec 27 to Jan 8
Dance Workshop
in the Rainforest

La Suerte — Jan 4 to Jan 18

 
Winter Dec. 27, 2008 to Jan. 17, 2009
. Course Choice Course Name Field Station Location



1st Choice Course
2nd Choice Course
3rd Choice Course

Dance Workshop
in the Rainforest
Short Session / Jan 4-Jan 18

La Suerte



1st Choice Course
2nd Choice Course
3rd Choice Course
Advanced Primate Behavior
& Ecology / Regular Session /
Dec 27-Jan 17
La Suerte



1st Choice Course
2nd Choice Course
3rd Choice Course
Comparative Skeletal
Anatomy & Function
Short Session / Dec 27-Jan 8
Ometepe


1st Choice Course
2nd Choice Course
3rd Choice Course

Primate Behavior & Ecology
Short Session / Dec 27-Jan 8

Ometepe

Yes, I will participate in the eco-challenge after the session
"Eco Challenge" optional trip
to Ometepe Island
Ometepe
 
Summer #1 May 25 to June 19, 2008
. Course Choice Course Name Field Station Location



1st Choice Course
2nd Choice Course
3rd Choice Course
Tropical Herpetology
Regular Session
La Suerte



1st Choice Course
2nd Choice Course
3rd Choice Course
Rainforest Ecology
& Conservation
Regular Session
La Suerte



1st Choice Course
2nd Choice Course
3rd Choice Course
Rainforest Ecology & Conservation/Entomology
Regular Session
La Suerte



1st Choice Course
2nd Choice Course
3rd Choice Course
Primate Behavior & Ecology
Regular Session
La Suerte


1st Choice Course
2nd Choice Course
3rd Choice Course
Primate Behavior & Ecology
Regular Session  
Ometepe


1st Choice Course
2nd Choice Course
3rd Choice Course

Global Ecology
The Univ.of Pittsburg
Special Session / May 4-May 30
  

La Suerte
Yes, I will participate in the eco-challenge after session #1
"Eco challenge" optional trip
to Ometepe Island
Ometepe
 
Summer #2 June 22 to July 17, 2008
. Course Choice Course Name Field Station Location



1st Choice Course
2nd Choice Course
3rd Choice Course
Primate Behavior &
Assessment – Bioblitz
Short Session / June 22-July 6
Ometepe



1st Choice Course
2nd Choice Course
3rd Choice Course
Primate Behavior & Ecology (Intermediate)
Regular Session
Ometepe



1st Choice Course
2nd Choice Course
3rd Choice Course
Advanced Primate
Behavior & Ecology
Regular Session
La Suerte
Yes, I will participate in the eco-challenge after session #2
"Eco challenge" optional trip to Ometepe Island Ometepe
 
Summer #3 July 20 to Aug 14, 2008
. Course Choice Course Name Field Station Location



1st Choice Course
2nd Choice Course
3rd Choice Course
Photographic Workshop
in the Neotropics
Short Session / July 27-Aug 9
Ometepe & La Suerte



1st Choice Course
2nd Choice Course
3rd Choice Course
Mixed Media
in the Rainforest
Short Session / July 20 - Aug 1
La Suerte



1st Choice Course
2nd Choice Course
3rd Choice Course
Primate Behavior & Ecology
Short Session / July 20-Aug 2
La Suerte



1st Choice Course
2nd Choice Course
3rd Choice Course

Neotropical Ethnobotany
Short Session / July 20 - Aug 2

La Suerte



1st Choice Course
2nd Choice Course
3rd Choice Course

Rainforest Ecology &
Conservation focus on Birds
Regular Session

La Suerte



1st Choice Course
2nd Choice Course
3rd Choice Course
Primate Behavior & Ecology
Univ. of Santa Clara
New Session / July 18-Aug 29
La Suerte



1st Choice Course
2nd Choice Course
3rd Choice Course
Primate Behavior & Ecology
Regular Session
Ometepe
Yes, I will participate in the eco-challenge after session #3
"Eco challenge" optional trip
to Ometepe Island
Ometepe
   
Select Here:
Name of Parent (s) or Gudardian :
Parent/Guardian Email :
Parent/Guardian Phone:
Parent/Guardian Address:
Name of Physician:
Physician's Phone Number:
Physician's Fax Number:
Physician's E-mail Address:
Insurance Provider:
Insurance Company Phone Number:
Insurance Card Number:
Biological Sciences or Ecology courses taken and related courses or research in which you have participated:
Special Skills, Certificates or Awards:
Travel Experience (Where/How Long):
Outdoor/Camping Experience:
Career Plans:
Can you swim: Yes No
Are you going on the "Ometepe Eco Challenge" ten day trip to Nicaragua? (For students traveling to Costa Rica only) Yes No
How did you hear about us?
Please fill out this application only if you are ready to commit to the program.


To formalize this application:
1-Print: a copy of what you filled out will be emailed to you immediately
after you hit the submit button.
2-Sign: Sign the bottom of the application and edit or complete any missing
information.
3- Mail the application along with a Registration fee(US$150.00 in US
currency and payable in USA banks)

Make the check payable to La Suerte Biological Field Station
La Suerte Biological field Station
PO BOX 55-7519 Miami FL 33255-7519

Applicant Signature:______________________Date:__________

By submitting this form, you are declaring the information which you entered is true. You will also be required to read and sign the release and indemnity agreement, waiver form, and the certificate of insurance form which will be forwarded to you. You will also be required to make a $150, $300 or $450 deposit, as described above.