Women's Weekend 2024 Primary Contact Name(Required) Address(Required) Street Address Address Line 2 City State ZIP Home Phone(Required)Work PhoneCell PhoneEmail(Required) Group InformationAttendee #1Name (First/Last) Birth Date MM slash DD slash YYYY Address (if different than above) Attendee #2Name (First/Last) Birth Date MM slash DD slash YYYY Address (if different than above) Attendee #3Name (First/Last) Birth Date MM slash DD slash YYYY Address (if different than above) Attendee #4Name (First/Last) Birth Date MM slash DD slash YYYY Address (if different than above) Attendee #5Name (First/Last) Birth Date MM slash DD slash YYYY Address (if different than above) Dietary needs, check all that apply: Vegetarian Vegetarian, Gluten Free Vegetarian, Dairy Free Vegan Vegan, Gluten Free Gluten Free Gluten Free, Dairy Free Dairy Free None of these How did you learn about Camp Manito-wish YMCA? Are you a Camp Manito-wish YMCA alum? Yes No If Yes, what was your name when you were a camper? Payment OptionsCamp Manito-wish accepts the following forms of payment. Note credit card payments will be charged a 2% convenience fee upon processing. Please make your selection below. E-Check Credit Card with 2% fee Paper Check (please mail to: Camp Manito-wish YMCA, PO Box 246, Boulder Junction, WI 54512) Payment Total ($300 per attendee)(Required) Bank Name (for eCheck) Account Type (for eCheck) Checking Savings Bank Routing Number (for eCheck) Please confirm number before continuing.Bank Account Number (for eCheck) Please confirm number before continuing.Credit Card Type Visa Mastercard Discover American Express Credit Card Number Please confirm number before continuing.Expiration Date (mm/yyyy) Security (CVV) Code The security code on the back of your card.Cardholder Address (if different than primary contact) Street Address Address Line 2 City State ZIP Consent(Required) I hereby give permission to use any video, photographs, or written statements from my family's experience in public relations materials, including the internet, without compensation.Cancellation policy: I understand that in the event of my cancellation within 21 days of the program, Camp Manito-wish YMCA will retain the full fee. Cancellation on my part within 22-60 days of the program will result in Camp Manito-wish retaining 50% of the program fee. For any cancellation more than 60 days before a program, Camp Manito-wish will retain 25% of the pro- gram fee.Signature (your full name)(Required) Date(Required) MM slash DD slash YYYY CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
