Registration Form
User Name*


This is the name you will use in both the main course web site and the course forum. Please use your first name (and part of your last name if you wish) as a username. Make sure that you use only letters and numbers and no spaces. Underline is OK. (Examples: christos_v, christos_vasilikiotis).
Password*

Choose a password for the course

Please re-enter your password
You will use this password to access the main course web site and the course forum. Save it in a safe place.
Name* First Last
Address

Street Address 1

Street Address 2 (cont.)

City

State or Province

Postal or Zip Code

Country

Email*

Re-enter your Email*

Note: It is very important that you provide your correct e-mail address. All correspondence will be sent by e-mail.

Gender

Male Female

Birth Date
MM DD YYYY
Background

Please take a moment to tell us a few things about yourself.

What is your background?

What are your interests as they relate to agroecology?

Why you are taking this course?

If you are a farmer or a full time student you may qualify for
a discount. Please choose one:

Farmer Student Do not qualify

Payment Method* Paypal - Online Credit Card Payment (major currencies)
Bank Transfer (in Euros)
Please indicate your preferred method of payment. Once you submit
this registration form you will be provided with full payment details
 

(* An asterisk indicates a required field)

By submitting this form I declare that:

  • I have provided correct information,
  • I will not publish, distribute or share access to program material without written authorization,
  • I will conduct myself in a respectful manner in all activities related to this program, and
  • I understand that breach of any of these provisions may result in my dismissal from this program.
 
   
   
 
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