Name of contact participant ___________________________Phone number _________________________
Address _______________________________________City/State/Zip__________________________
Email address _________________Number of people in camp __________
Your anticipated date and time of arrival is: __________
Set up may begin at 9:00 am on Thursday, October 20th (or with prior notification if needed).
Check the following that apply:
_____Pre-registering my camp (received on or before October 1st, 2005) $15
_____Registering my camp (received after October 1st) $20
I will abide by the Rules and Regulations of this encampment
Signature ______________________________mail to : Shelly Williams, 2696 Lippincott Road, West Liberty, Ohio 43357.