09 thru 12 September 2010
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click HERE for a printable PDF of the registration form
The information requested within the box must be completed.
IF YOUR REGISTRATION IS INCOMPLETE, IT WILL BE RETURNED TO YOU UNPROCESSED. IF YOU STILL DESIRE TO ATTEND, RESUBMIT A COMPLETE REGISTRATION FORM. If you are not attending this campout and have not attended since 2005 and
desire to continue receiving announcement flyers, please return this form with items 1, 2 and 3.c completed.
1. YOUR NAME: 2. YOUR COMPLETE MAILING ADDRESS: 3. PHONE NUMBERS, INCLUDING AREA CODE
4. E-MAIL ADDRESS: ________________________________@______________________ |
5. Is this your first campout? _______________ If so, who is your camp out sponsor? ________________________
6. How many campouts have you attended? ______________
7. How many years of sobriety? __________________
$_______________ CAMPING FEES: $75.00 for 9 thru 12 Sep 2010. If you are arriving early, make arrangements directly with Pine Cliff Resort.
$_______________ GOLF FEES: ($90.00) Please note: The golf fee only covers the green fees at Sierra Star. All prizes, trophies, etc are donated by the players. Please contact Mike Kreger, in Bakersfield at 559-647-7705 or Rufus Ethington, in San Diego at 619-890-6894, if you have items to donate.
Please indicate handicap or low score broken.
Handicap_____. Broke 100 ___. Broke 90 ___. Broke 80 ___. Broke 70 ___.
$_________________ Total fees paid (Camping, Golf, and Donations)
13 August 2010 is the cut off date for registration. Your registration must be in by that date to give us time to order the sweatshirts and other provisions.
Thank you for your help and assistance.
Make your checks or money orders payable to:
Coronado, CA 92178
_____________________________________________________________________________________
MAKE ALL CHECKS OR MONEY ORDERS PAYABLE TO:
“BROKEN NECK TROUT CAMPOUT”
P.O. BOX 180399
CORONADO, CA. 92178
ONLY ONE REGISTRATION PER FORM
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