2009 Centralia Campout Registration Form
Name(s)_______________________________ _______________________________ _______________________________
Name(s)_______________________________ _______________________________ _______________________________
Please indicate children’s ages.
Street address, Apt No. or P.O. Box Number, City/State/Zip
________________________________________________________________________________________
Home Phone___________________Cell Phone_________________ Email___________________________________________________
# of Campers: ___@ $50 $__________
Children 12 and under: ___@ Free!!
My total donation is:
$__________
I want to be included on a participant's list so other campers who attend the COTMC may contact me. (circle one) Yes No
I will be bringing Fido. (circle one) Yes No
Car Make/Model______________________________ License Plate #/State________________
