Application - Northwest Passage - Labor Day Camp 2010

Name(s) of adult participant(s):

____________________________________     male     female   (circle one)

____________________________________     male     female   (circle one)

Address ____________________________________________

City ________________________  State ______ Zip ________

Phone (day) _________________   (eve) __________________

e-mail ______________________________________________


Name and age of each non-adult:

________________________________
_______________________________________

Special dietary needs:

________________________________
_______________________________________


I do want my address/phone/e-mail to be listed on the camp roster:

    (circle one)       yes       no

(names & addresses on roster may be shared with other dance event organizers)


Sleeping accommodations
(circle one):


    women-only         men-only        adult couples

    tent                     motel             families with kids

    car/RV (Car/RVers:we will contact you re details)


Enclose full payment with this application:
Postmarked on or before June 15 - $270/$250* per adult, $80 per 10-18 yr-old, $50 per 2-9 yr-old
                                                     $150 per student (full-time, college or beyond; include copy of student ID)
Postmarked after June 15 - $295/$275* per adult, $90 per 10-18 yr-old, $60 per 2-9 yr-old
                                         $170 per student (full-time, college or beyond; include copy of student ID)
   * Adults: The lower price applies if you will provide your own tent, RV, or motel room.

I am applying for a work-trade position (circle one):
          yes       no
If yes,and one is not available, I want to attend at full price (circle one):       yes       no
   (Either way, include full payment now - $75 will be rebated later)

Make check payable to PCDC.   Mail this application and your check to:

    Northwest Passage

    c/o Karsten Kelly
    1404 SE 53rd Avenue
    Portland OR 97215

To reduce our expenses, all of our communications to you will be via e-mail.
If you would prefer snail mail. please check here: [  ]