John Muir Mountain Day Camp
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Sign me Up for the John Muir Mountain Day Camp!

Registration Form

(Please Print this page out, and fill it out clearly)

Choose which session you would like to attend:

___ Session One: August 6-10, 2007

___ Sesson Two: August 13-17, 2007

Student Name: ______________________________________________________

Student Age: _______________________________________________________

Parent/Guardian: _____________________________________________________

Home phone: ________________

Work Phone:_________________

E-mail Address: ___________________________________________

Address: ________________________________________________

City ________________________________________State _______

Method of payment (circle):    Cash    Check    AmEX    Visa    MC

Card Number: ________________________________________________________

Expiration Date: __________________

Amount: $225.00

Signature: ________________________________________________________

Mail form and Fees to:

Willows Theatre Box Office
Attn: John Muir Mountain Day Camp
1425 Gasoline Alley
Concord, CA 94520

Telephone: (925) 798-1300
Fax: (925) 676-5726
E-Mail: info@muircamp.org
Web: www.muircamp.org