Camp Michawana Registration Form
Women Retreat 2012
Name ____________________________________________
Address __________________________City _______________ST ___ Zip _______ Phone ___________
Church/Group ___________________________________________ City ________________
Payment Type: Check Visa MC Discover Card # __________________________________
Exp. Date ____/____
Sec. Code _________
Name on Card __________________________ Signature ______________________________
Registration Fee: $ _____________ _____ Entire Weekend $90.00
Deposit: ($40.00) $ _____________ _____ Retreat Only (without lodging) $60.00 Balance Due $ _____________ _____ Saturday Only (with meals)
$45.00
_____ Staying in own RV for weekend $90.00
In consideration of Camp Michawana accepting and permitting the above named to attend & participate in camp's activities. I agree that Camp Michawana, a non-profit corp. its agents, officers, employees, trustees and volunteers will not be liable for any injury, death, damage and/or loss to me and/or anyone claiming on the named behalf, I further agree to hold harmless, indemnify and defend Camp Michawana, whether such injury, illness, or damage occurs on or off camp premises.
___________________________________________________________ _____________
Please send this slip with deposit to Camp before Sept. 25, 2012
Camp Michawana, 5800 Head Lake Rd. Hastings, MI 49058