Registration

Please fill out the form below to register.

Justus venturing Organization
1895 Bush Ave 
Saint Paul Mn 55119
(612)396-4863
 
 
Name (Person attending the trip)
Event(s) 
Name of contact person
Home Phone          
Work Phone
Fax      
Email 
Address  
State           
Zip Code
 

The Justus Venturing Registration process is easy.

Simply complete each step below and if you have questions, feel free to call us at  612 396-4863.

Step 1

Please send us a copy of a physical exam (within the last year). If the individual has a risk management or risk
      assessment, please include it with your registration.

Step 2

Please fill out the personal experience plan provided for you. Indicate N/A for the sections that do not apply. Complete a plan for each participant.
 

Step3  

If you are paying privately, please remit full payment with your registration packet. If you are unable to make he full payment now, please contact Michelle Slade at      612 396 4863 in order to complete the registration process.

Step 4 

Press print below and mail this form and your  form to the address listed on the Contact Us page.

 If we need to bill an outside agency, such as the state or country, please provide us with the following information**

 

Title
Billing Contact Person
Address 
State 
Zip code
Phone

        

 

Please fill out our (PEP) Personal Experience Plan after you print this page