CAMP BLANDING RETREAT â Registration Form
CAMP BLANDING RETREAT – Registration Form Please make checks payable to: Olde Green Cupboard Designs 4861 Blackwood Forest Dr. Jacksonville, FL 32257 904-742-1100 [email protected]
SIMS CENTER BUILDING – Located by the Post Exchange & Barber Shop ______ July 31 - August 4, 2015
GOLD STAR PROGRAM
______ September 25 – 29, 2015
3 DAY/$50.00 _____
5 DAY/$75.00 _____
3 DAY/$50.00 _____
5 DAY/$75.00 _____
Sign up for lodging on www.oldegreencupboard.com when notified by email. One of the following is required prior to entering Camp Blanding - NO EXCEPTIONS: Driver’s License Number:
State:
Exp. Date:
State Identification Card Number:
State:
Exp. Date:
Military Card Identification Number:
USA – USN – USMC - USCG
Last Name:
First Name:
Address:
City, Sate, Zip:
Home Phone:
Cell Phone:
Exp. Date:
Email address (PLEASE PRINT)
Do you have food allergies:
Medical Issues?
Sign Here: _______________________________________________________________________
Emergency Contact:
Phone:
Relationship: All fees paid/deposited to/with Olde Green Cupboard Designs/Gloria Parsons are non-refundable OR EXCHANGEABLE 21 DAYS PRIOR TO THE FIRST DAY OF THE RETREAT. Attendee agrees to hold harmless Camp Blanding Joint Training Center – to include all employees (military/civilian/contact), Gloria Parsons and/or Olde Green Cupboard Designs for any damages, losses, or injuries that may occur while traveling to and from the retreat or during the event.
Cash
_________________
Check #
_________________
Sale Room
________________
Email Added
_________________
Other
_________________
Revised: 1/27/2015
SIMS CENTER BUILDING – Located by the Post Exchange & Barber Shop ______ July 31 - August 4, 2015
GOLD STAR PROGRAM
______ September 25 – 29, 2015
3 DAY/$50.00 _____
5 DAY/$75.00 _____
3 DAY/$50.00 _____
5 DAY/$75.00 _____
Sign up for lodging on www.oldegreencupboard.com when notified by email. One of the following is required prior to entering Camp Blanding - NO EXCEPTIONS: Driver’s License Number:
State:
Exp. Date:
State Identification Card Number:
State:
Exp. Date:
Military Card Identification Number:
USA – USN – USMC - USCG
Last Name:
First Name:
Address:
City, Sate, Zip:
Home Phone:
Cell Phone:
Exp. Date:
Email address (PLEASE PRINT)
Do you have food allergies:
Medical Issues?
Sign Here: _______________________________________________________________________
Emergency Contact:
Phone:
Relationship: All fees paid/deposited to/with Olde Green Cupboard Designs/Gloria Parsons are non-refundable OR EXCHANGEABLE 21 DAYS PRIOR TO THE FIRST DAY OF THE RETREAT. Attendee agrees to hold harmless Camp Blanding Joint Training Center – to include all employees (military/civilian/contact), Gloria Parsons and/or Olde Green Cupboard Designs for any damages, losses, or injuries that may occur while traveling to and from the retreat or during the event.
Cash
_________________
Check #
_________________
Sale Room
________________
Email Added
_________________
Other
_________________
Revised: 1/27/2015
