105th Anniversary Celebration Registration - Camp Manito-wish YMCA Summer Camp

Name(Required)

First Last

Maiden Name (if alum)

Birth Date(Required)

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Street Address Address Line 2 City State ZIP

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Home Phone

Email(Required)

Will Attend:

Lunch

Dinner

Dietary needs, check all that apply:

Volunteer?

I am willing to volunteer during the weekend. Please contact me regarding available opportunities.

Additional Participants

Attendee #1

Name

First Last

Maiden Name (if alum)

Birth Date

Address (if different than main contact)

Email (if different than main contact)

Dietary needs, check all that apply:

Will Attend:

Lunch

Dinner

Volunteer?

I am willing to volunteer during the weekend. Please contact me regarding available opportunities.

Attendee #2

Name

First Last

Maiden Name (if alum)

Birth Date

Address (if different than main contact)

Email (if different than main contact)

Dietary needs, check all that apply:

Will Attend:

Lunch

Dinner

Volunteer?

I am willing to volunteer during the weekend. Please contact me regarding available opportunities.

Attendee #3

Name

First Last

Maiden Name (if alum)

Birth Date

Address (if different than main contact)

Email (if different than main contact)

Dietary needs, check all that apply:

Will Attend:

Lunch

Dinner

Volunteer?

I am willing to volunteer during the weekend. Please contact me regarding available opportunities.

Attendee #4

Name

First Last

Maiden Name (if alum)

Birth Date

Address (if different than main contact)

Email (if different than main contact)

Dietary needs, check all that apply:

Will Attend:

Lunch

Dinner

Volunteer?

I am willing to volunteer during the weekend. Please contact me regarding available opportunities.

Attendee #5

Name

First Last

Maiden Name (if alum)

Birth Date

Address (if different than main contact)

Email (if different than main contact)

Dietary needs, check all that apply:

Will Attend:

Lunch

Dinner

Volunteer?

I am willing to volunteer during the weekend. Please contact me regarding available opportunities.

Attendee #6

Name

First Last

Maiden Name (if alum)

Birth Date

Address (if different than main contact)

Email (if different than main contact)

Dietary needs, check all that apply:

Will Attend:

Lunch

Dinner

Volunteer?

I am willing to volunteer during the weekend. Please contact me regarding available opportunities.

Attendee #7

Name

First Last

Maiden Name (if alum)

Birth Date

Address (if different than main contact)

Email (if different than main contact)

Dietary needs, check all that apply:

Will Attend:

Lunch

Dinner

Volunteer?

I am willing to volunteer during the weekend. Please contact me regarding available opportunities.

Attendee #8

Name

First Last

Maiden Name (if alum)

Birth Date

Address (if different than main contact)

Email (if different than main contact)

Dietary needs, check all that apply:

Will Attend:

Lunch

Dinner

Volunteer?

I am willing to volunteer during the weekend. Please contact me regarding available opportunities.

Attendee #9

Name

First Last

Maiden Name (if alum)

Birth Date

Address (if different than main contact)

Email (if different than main contact)

Dietary needs, check all that apply:

Will Attend:

Lunch

Dinner

Volunteer?

I am willing to volunteer during the weekend. Please contact me regarding available opportunities.

Event Registration Fee

In lieu of a registration fee, to assist in offsetting the costs of the 105th Anniversary celebration, we ask that you join us by providing a donation of $105, $250, $500, $1,005, $5,000, or other amount. If you are interested in sponsoring the weekend opportunities including meals starting at $1,000 or more, please contact Jeff Pereles at jeff.pereles@manito-wish.org. Acknowledgement of all sponsorships will be displayed at registration and Nash Lodge.

Yes I would like to make a tax deductible contribution to Camp Manito-wish YMCA to the 105th Anniversary Fund in the amount of:

I would like may name listed in publication as:

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Street Address Address Line 2 City State ZIP

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Additional Participants

Attendee #1

Attendee #2

Attendee #3

Attendee #4

Attendee #5

Attendee #6

Attendee #7

Attendee #8

Attendee #9

Event Registration Fee

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