Registration Form

This form can be printed by using your printer function on your browser file feature.

For Youth currently in 7th - 12th Grades

Please Send this form and your check:
The Fee is $160 ($20.00 off) if you register before April 15th!
The Fee is $170.00 ($10.00 off) if you register before May 15th.
After May 15th, registration is $180.00


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Name

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Grade (2008-2009 School Year)

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Address

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City

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County

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Email Address

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Evening Phone #

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Daytime Phone #

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Cabin Buddy

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Parent/Guardian Signature Date

Special Diet Requirements: Yes____   No____

Gender: M______ F______

Type of Camera you will be using (circle): Point & Shoot   Adjustable SLR


For More Information, E-mail:
iowa_4h_photocamp@yahoo.com

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