grace is over 50 | Registration

WHAT WE NEED TO KNOW ABOUT YOU…
Name

FirstLast
Address

Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Contact Information

EmailHome tel.
Work tel.
Emergency Contact Information

Name of Person
Phone numberRelation to You
BOOKING INFORMATION
Ace Camp

Name of Ace Camp
Additional Health Information

Dietary Restrictions or Food Allergies and/or medical conditions we need to be aware of:
ACCOMMODATIONS...
Is there anyone who you would like to occupy a room with?

note: tent rooms are single. Boutique hotel rooms are shared.
INSURANCE...
Additional information

Yes No
Declining Insurance Coverage

Yes No
HOW WOULD YOU LIKE TO PAY?
Payment information

Cheque Visa Mastercard Amex

Registration Form