LOMT 2012 Pioneer Camp Reservation Form

All required fields are marked with an*
Church Name:*
Group Name:
Church Mailing Address:*
City:* State:* Zip:*
Church Phone:* ( ) - Church Fax: ( ) -
Group Leader:*
Position:* Day Phone:* ( )- Cell Phone: ( )-
E-Mail address:*

Pioneer Sessions

Pioneer 1 (June 3-8)
Pioneer 2 (June 10-15)
Pioneer 2, Camp Shiloh (June 10-15)
Pioneer 3 (June 17-22)
Pioneer 4 (June 24-29)
Pioneer 5 (July 1-6)
Pioneer 8 (July 22-27)
Pioneer 9 (July 29 - Aug 3)
Pioneer 10 ( Aug 5-10)

Number of campers participating in each program:
Alpha (available in sessions 1, 2, 3, 4, 5, 8, 9, 10) males females
Omega (available in sessions 1, 2, 4, 5, 9, 10) males female
Night Owl (available in sessions 3, 9) males female
Alliance (available in sessions 3, 8) males female
Camp Shiloh (available in session 2) male female
Number of Leader / Resource Persons Attending: male female

Deposit: A $50 per camper, non-refundable, non-transferable deposit
is required to reserve space(s).
Total Number of campers attending* X $50 = Total Deposit
Total Due:*