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: [ ]