Mid States Swim Camps
Registration Form –
2007
Name________________________________ 100
Free Time_________________
Address___________________________________________________________
City_____________________________State__________Zip_________________
Phone ( ) _______________Birth
Date_____________ Age _____ Sex_____
Parents’ or Guardians’ Names
_________________________________________
E-Mail ______________________________
T-Shirt Size (Adult Sizes)
S M L XL
Roommate Choice __________________________________________________
Insurance Company
_______________________Policy No.: _________________
June 10-14 St. Mary’s University (
June 17-21 St.
Mary’s University (
June 17-21 St. Mary’s University (
June 24-28
Recommended ages 14 and under
July 8-12
July 29-Aug 2 UW-Whitewater (
July 29-Aug 2
I
attended Mid-States Swim Camps last year!
I would like to be in the Special Training Group at St. Mary’s
University on June 17-21
My second choice
campsite, if the first is filled, is _____________________________
Date
_____________________________________________________________
Deposit is non-refundable and non-transferable and
must accompany this registration.
Balance is due 30
days before the camps are scheduled.
Deposit is $100.00
per session. Payable to: MID-STATES
SWIM CAMPS
CALL: (262)
334-1213 if you have any questions or concerns
Fax No: (262) 334-1228
E-mail: midsts@nconnect.net
Web Page: www.nconncet.net/~midsts
CANCELLATIONS:
Full payment must be received in writing at least 30 days
Prior to the
enrollment date. All cancellations are
subject to a $50.00 service charge.
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Do Not Detach – For Office Use Only.
Date Rec’d
____________ Date Conf’d
____________ Date Ent ____________
Deposit:
Am’t Rec’d
____________ Ck. No.: ____________ Ck.
Date: ____________
Balance Due:
____________
Am’t. Rec’d.
____________ Ck. No.: ____________ Ck. Date: ____________