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, July 27th (or with prior notification if needed).
Check the following that apply:
_____Pre-registering my camp (received on or before July 1st, 2005) $25
_____Registering my camp (received after July 1st) $30
_____Registering my camp as a vendor $35
_____Extra medallions ($5 each)
I will abide by the Rules and Regulations of this encampment
Signature ______________________________mail to : Shelly Williams, 2696 Lippincott Road, West Liberty, Ohio 43357.