Men's Retreat (Sept 10-12)

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Newsletter Spring 2010

Men's Retreat (Sept 10-12)

Note: Camper's family insurance plan is the primary source of coverage for accidents.

Name:
Age:
Birthdate:
Home Phone:
Cell Phone:
Mailing Address:
Email:
Emergency Contact Name:
Emergency Contact Phone:
Emergency Contact Relation:
Insurance Carrier:
Primary Insured:
Policy Number:
Family Physician:
Family Physician Phone:
Date of last Tetnus shot:
Dietary and Special Needs:
Allergies:
Lodging Preference:
Camp Roommate:
Camp Attendance:
Please send me a camp newsletter:
Yes, my photo can be used in promotionals:
Activities - Skeet Shooting:
Activities - Paintball:
Activities - Wave Runners:
T-Shirt Size: