Registration

Director Name *:

Title *:

Phone *:

Extension:

Fax:

Address *:

City *:

State *:

Zip *:

Camp Name*:

Camp Address*:

City*:

State *:

Zip *:

Camp Website URL :

Is this camp a charitable organization under I.R.C section 501 (c)(3)?*:

Association:

Affiliated With a Hospital :

P.O.Box addresses are not acceptable.

Correspondence Name:

Title:

Phone:

Extension:

Fax:

Address:

City:

State :

Zip:

Email *:

Confirm Email *:

Password *:

Confirm Password *:

Password Hints:

Security Questions *:

I agree to the Terms and Conditions above.