Name______________________________________
Street______________________________________
City __________________ State ____________ Zip _____________
County ______________________________ Phone (______)_________________
e-mail: ___________________________________________________
_______PLEASE CHECK IF YOU DO NOT WANT YOUR
INFORMATION PUBLISHED IN CAMP BOOKLET.
Are you a New Camper (for this camp)?____________ Yes ____ No _______
If no, how many years (including 2007) will you have attended camp? __________
Cabins will be assigned this year. We will do our best
to meet everyone’s request. Please note whether you want to be in a certain cabin or just with certain cabin mate(s).
If you have a serious medical condition, you may request Piatt Lodge.
If you have limited mobility, you may request Cabin 1 or Cabin 2.
Piatt Lodge Assist Companion: Willing to take an upper bunk? Yes__No__
Preferred Cabin # ______________ Cabin Mate (s) ________________________
FEE for Camp: $100
(Craft Fees are not included in this fee) Send check and registration form to:
Sue Ferrill
3420 Bell Road
Minooka, IL 60447
Registration Deadline - June 1, 2007
In order to have T-shirts for camp, please enclose money order and payment with your registration. Must have shirt
order and money by June 1, 2007
(circle: Size, shirt, and price)
Color for year 2007 - Royal blue with white
Sweatshirt T-Shirt
S M L XL
$18.00
$13.00
2XL
21.00
15.00
3XL 4XL
23.00
16.00
NEW! Nightshirt $20.00
T shirt fabric - One size fits most
