United Church Camp Meeting Association

Berwick Camp

United Church Camp Meeting Association

Page 1 of 3

2015Registration Form

Camp Dates: Friday July 24thto Sunday August2nd

Please mail registration to:

Berwick Camp Meeting Registrars

c/o Brian & Krista Rietzel

14 Sandalwood Drive

Moncton, NB, E1G 1Z9

For additional information, please r call506-854-3218.

Please send both your completed registration form and the registration feeto the Registrar by May 11th.

Returning campers’spaces cannot be guaranteed after this date.

Page 1 of 3

Please Print:

Contact Name: ______

Address: ______

Telephone: ______Plate Number: ______

Email: ______

Please list below the names of ALL people to be attending Camp (including you!). Use Grade space to indicate the grade of any school childrenas of the September 2015 school year (K-12) or the code (N, PS, A, S) for others.

N = Infant-NurseryPS = Preschool= year before Primary/Kindergarten

A = AdultS= Adult Student (post-secondary)

First Name / Last Name / Grade/Code / First Name / Last Name / Grade/Code
1 / 6
2 / 7
3 / 8
4 / 9
5 / 10

2015 Berwick Camp Accommodations

Page 1 of 3

Camp starts at suppertime on Friday July 24thand ends at noon on Sunday August 2nd. Campers who intend to be at camp before the opening date must contact the Registrar and pay the nightly rate.

Arrival Date:______Departure Date: ______

Accommodation Requested:Second Choice: ______

If CAMPING, please indicate: TENT TRAILER Size (in feet) _____ RV Size (in feet); _____

Comments:

______

______

Does anyone have any disabilities that we should be aware of?

Page 1 of 3

Page 1 of 3

FEE CALCULATION

Registration FEES (must accompany registration form)

Registration Type / Cost per person / Number of People / Total Amount
Adult / $75
Adult Student(post-secondary) / $50
Child / $25
TOTAL REGISTRATION FEE / $

Accommodation FEES

Accommodation Fee (see brochure) / $

Other FEES

Fridge Rental ($25) / $
Meals (see brochure) / $
Donation / $

TOTAL CAMP FEES (Total Registration + Accommodation + Other) = $______

PAYMENTS

FULL FEES MUST BE PAID by July 1st.

Accommodations not paid for by this date will be made available to others on the waiting list.

1. The minimum initial payment required with the registration form is the TOTAL REGISTRATION FEE calculated above. (Note: Complete payment with registration is preferred as it reduces the workload and the banking fees charged to Berwick Camp.)
2. Post dated cheques (for no later than July 1, 2015) or credit card authorization below must accompany the registration form for the full balance.

Initial Payment / Balance (by July 1, 2015)
Amount by PAR / $ / $
Amount by Cheque / $ / $
Amount by Credit Card / $ / $
TOTAL / $ / $

CREDIT CARD AUTHORIZATION

Page 1 of 3

Credit Card Type : □Visa□MasterCard

Credit Card # Exp. Date:

I,,authorize Berwick Camp to charge my credit card as indicated above for initial payment and/or balance owing.

Make cheques payable to:

United Church Camp Meeting Association

Page 1 of 3