Please print and mail this form to the address at the bottom.

2001 Ohio-Meadville District Summer Institute Registration Form

First Camper

Name (as you want on name tags): ___________________________________

Male.___ Female.___ Church/Society: ______________________________________

If Child/Youth, give date of birth: ________

Complete address: _____________________________________________

__________________________________________________________

Area Code & Phone Number: ___________________ Email: ___________________

I would like to join:

1st choice _____ and 2nd choice _____ for morning workshop

What volunteer activities would you prefer (pick at least 2)?

________________________________________________________

________________________________________________________

Second Camper

Name (as you want on name tags): ___________________________________

Male.___ Female.___ Church/Society: ______________________________________

If Child/Youth, give date of birth: ________

Complete address: _____________________________________________

__________________________________________________________

Area Code & Phone Number: ___________________ Email: ___________________

I would like to join:

1st choice _____ and 2nd choice _____ for morning workshop

What volunteer activities would you prefer (pick at least 2)?

________________________________________________________

________________________________________________________

Third Camper

Name (as you want on name tags): ___________________________________

Male.___ Female.___ Church/Society: ______________________________________

If Child/Youth, give date of birth: ________

Complete address: _____________________________________________

__________________________________________________________

Area Code & Phone Number: ___________________ Email: ___________________

I would like to join:

1st choice _____ and 2nd choice _____ for morning workshop

What volunteer activities would you prefer (pick at least 2)?

________________________________________________________

________________________________________________________

Fourth Camper

Name (as you want on name tags): ___________________________________

Male.___ Female.___ Church/Society: ______________________________________

If Child/Youth, give date of birth: ________

Complete address: _____________________________________________

__________________________________________________________

Area Code & Phone Number: ___________________ Email: ___________________

I would like to join:

1st choice _____ and 2nd choice _____ for morning workshop

What volunteer activities would you prefer (pick at least 2)?

________________________________________________________

________________________________________________________

Special Needs

If you wish to be included in the Young Adult program, please indicate YA for workshop choice.

____ This is my first visit to OMDSI

Please enter any special needs (dietary, physical limitations, or room requirements below):


Special parking needs?

If you plan to room with someone who is registering on a seperate form, please specify here:

Fees:

Standard Housing

   Ages 5 and under ___ x  $75 = ___________

   Ages 6 to 12     ___ x $275 = ___________

   Ages 13 and up   ___ x $335 = ___________

   Single Room      ___ x $435 = ___________

Air Conditioned Housing

   Ages 5 and under ___ x  $75 = ___________

   Ages 6 to 12     ___ x $325 = ___________

   Ages 13 and up   ___ x $385 = ___________

   Single Room      ___ x $435 = ___________

Other

   Leadership Track    Add $50 = ___________
   per person

   SI T-Shirts      ___ x  $12 = ___________

   Subtotal                      ___________

T-shirts

SI '01 T-shirts (optional - must be preordered) @ $12
Select size and quantity:

Adult XL ____ Adult L____ Adult M____ Adult S____ Child L____ Child M____ Child S____

Totals

Enter subtotal here:                    ___________

Deduct $50/child (ages 3 and up) 
using floor space or own cot in 
adult's room  (both beds occupied)     - __________

Scholarship Fund Donation              + __________

Computer use $5 per family             + __________

Add $25 late registration              + __________
(after June 1st) 

Total due:                              ___________

Deposit (at least half of full amount): ___________

Balance due on arrival:                 ___________
Please send this form and a check for the amount above to to complete your registration.