Registration Form Tetons/Yellowstone 2025

LeAnn Stamper Photography www.leannstamper.com 919-422-9541 leannstamperphotography@gmail.com

First Name

Last Name

Cell Phone

Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Birthdate

Medical Conditions

Dietary Requirements

Fitness Level

Please select from the following:

Low
Good
Excellent

Emergency Contact Info:

First Name

Last Name

Phone

Relationship

Select

Add

Terms and Conditions

In order to register, you must agree to the Terms and Conditions. Trip insurance is highly recommended here is just one example of the many that are available.

Accept Terms and Conditions

Yes I agree to the Terms and Conditions
Yes I am aware of the potential costs of not purchasing travel insurance

Payment below for your deposit will finalize your registration and secure your spot for this trip.

Billing Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Sub Total

$2,000.00

TOTAL

$2,000.00

Payment Method

PayPal
Credit Card

Credit Card Type

Select

Name on Card

Credit Card Number

Expiration Date

Month

Year

Verification Number

Signature

Typing your name in the space provided will serve as your signature for this transaction

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