Middle School Mania 2010

October 22-24, 2010

On-line Registration Form

Registration Deadline and Costs:

after October 5, 2010: $85.00

Registrations received after October 8th may not receive a t-shirt. Registration must be received by October 15th

Name (as to appear on your nametag):

Male
Female

Mailing Address:

City: State: ZIP:

Phone: Emergency Phone:

T-Shirt Size:

Your Congregation:

Your Youth Leader :

Email address for confirmation and updates :

Parent / Guardian Name:

I hereby give my permission for my son/daughter to attend Middle School Mania at Canyonview Camp, Oct 22-24, 2010. I understand that in the unlikely event of an accident or illness, every effort will be made to contact me at the phone numbers given above. In the event that I cannot be reached, I hereby authorize the adult leaders of Middle School Mania to take whatever medical attention deemed necessary, including securing the opinion of a physician or hospitalization.

Photo Release:

This camper may appear in photos or film used for the promotional purposes of The Presbytery Of The Cascades events
This camper may NOT appear in photos or film used for the promotional purposes of The Presbytery Of The Cascades events

REGISTRATION FEE:

Early-bird fee ends October 5, 2010

	Qnty	Price/person
ADULTS / YOUTH		$80.00
		Total:	$

* you will be contacted if you do not receive one

Credit Card Information on next page

For questions contact Angela Mansfield, Email