| Creation Registration Name ___________________________________________ Phone _______________________ Grade __________ Email __________________________________________________________ COST: $160 ($50 non-refundable deposit due by Wed., May, 19th; balance due Sun., June 27th) Check enclosed Charge Credit Card Card # ________________________________________ Exp. Date _______________ Security Code ________ Name on card _______________________________________________ Please note if you have any special diet requirements: __________________________________________________ Bringing a tent? Yes ___ No ___ Tenting with someone else? Yes ____ No ____ Tenting with whom? __________________________, ___________________________, ________________________ |
Print this out and hand in or mail to
Brian Kisler
1895 Wrightstown Rd
Washington Crsng, PA 18977-1323