Lake Huron 2012 Lakeshore Interlude - 3 per room

*First Name
*Last Name
*Email
*Gender
Female
Male
*Address
*City
*State
*Zip Code
*Home Phone Please include area code
Daytime Phone Please include area code
Roommate Request
Local Church Please provide church name and city
Pastor's Name
Donation to the Campership Fund (0ptional) Please consider a donation to help needy children and youth attend church camp. You may check several boxes to set donation amount. Thank you!
Make a donation ($25)
Make a donation ($50)
Make a donation ($100)
Make a donation ($200)
Make a donation ($500)
*Release of Liability Checking this box indicates that you have read and agree to our Release of Liability form, located here . We regret that we are unable to accept registrations without a positive response to this question. Please print and sign this form and bring with you to camp.
Yes
No
*Registration Fee (3 person shared room) ($150) Check this box and click the submit button below. On the next page, click the "pay now" button to complete registration. We are unable to accept online registrations without full credit card payment.
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