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Program Registration



General Registration Information
click here if you are registering for overnight summer youth camp; all others proceed here.                    Registration is complete when you've clicked the 'submit' button at the end of the form. Fields marked with an asterisk (*) are required:
Name of Program*:
 Name of Registrant*: 
Mailing Address*: 
email address (for confirmation purposes)*: 
Home Phone*: 

Name(s) of additional persons attending (if any): Include ages if participants are children.

 

You may use this space for other comments if needed.


Grandfolk/Littlefolk day only:
Pre-order t-shirts:  sizes youth small - adult XL, only $6 each. List number of shirts and sizes desired here.  Shirts must be pre-ordered by June 16.  (Shirts purchased after June 16 are $10 each; sizes subject to availability)

To prevent spam, please enter the first four letters of the name of registrant here*:. (These letters MUST be the same as what you entered under Name of Registrant above, case sensitive.)

Some programs may require additional information.  This information will be included with your email confirmation.  
Upon receipt of this registration we will email you a registration confirmation.  Please make sure the email address included is correct and is currently used by you.

 
 

2830 Coppock Rd, Washington, IA 52353  •  Phone: (319) 653 - 3611  •  Fax: (319) 653 - 3611

Southeast Iowa Mennonite Camping Association