"Dr. Seuss" Michigan Fall 2011 Registration Form
Name:
Address:
G.S. #
Phone #:
Type Unit:
City:
State:
Zip:
Make:
First Samboree:
Unit Lic #:
Vendor:
First MI Samboree?:
Chapter  Name:
Handicapped?
Adults:
Children (>13:
Teens (13-18):
Checks payable to: Michigan Good Sam Organization, print and send this registration form with fee to: Christine Farr, 16400 Upton Road # 99, East Lansing, MI  48823-9305.  Deadline for pre-reg is August 25, 2011.
Country:
Expires:
If Yes, Hdcp Lic #:
Registration Fee:
Extra nights: @ $15.00:
Extra Adults @ $10.00 each
Craft Table Rental:
Vendors Fee:
Total U.S. Funds Enclosed:
We, the undersigned, understand the Michigan Good Sam State Committee has taken reasonable and necessary precautions, and therefore, we accept full responsibility for our unit and person's with our unit while attending the Michigan "Dr. Seuss" Fall Samboree at Otisville, MI.
                                                                     Signature:____________________________________________
YOUR CANCELLED CHECK IS YOUR CONFIRMATION!
Please make sure all boxes are marked appropriately and you have signed below!  Thank you!
Your Email Address:
PLEASE FILL IN THIS FORM COMPLETELY
This Information is used at our rallies in case we need to get ahold of you in an emergency and will also save you time at registration or save you a walk in bringing it back to registration!
ALL ABOVE INFORMATION IS IMPORTANT AND REQUIRED!!