Name of Group
Contact Person
Address
City State ZIP Telephone
Fax
E-Mail Address

Is your Group a:
Resident Group Commuting Group Both

Dates Requested:
1st Choice
2nd Choice
3rd Choice

Anticipated Numbers:
Total Adults Children/Youth

Food Service:
First Meal
Last Meal
Catered Meals

Did your camp or conference meet in summer 2009?
Yes No
Name and address of Facility
Name and Telephone of contact person

Funding Source for your camp or conference:

Facility Needs:
1.
2.
3.
4.