Camp Fircom Registration: Camp Unplugged 2019
This is the registration form for Canadian Memorial United Church's congregational retreat at Camp Fircom, May 24-26, 2019. This year's theme is *Camp Unplugged*. Join us as we unwind and relax in the beauty of nature during a weekend getaway with your Canadian Memorial family. (Note: No payment is required at this time. This registration is to gather the information needed to plan the weekend. You'll be contacted later in April regarding payment.) THANK YOU!
HOUSEHOLD / FAMILY INFORMATION
Adult #1 Name (Title/First & Last Name) *
Your answer
Street Address: *
Your answer
City/Province *
Your answer
Postal Code *
Your answer
Birthday *
MM
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DD
/
YYYY
Primary Phone Number *
Your answer
Alternate Phone Number
Your answer
Email *
Your answer
ADULT #2 NAME (Title/First & Last Name) - if required
Your answer
Street Address:
Your answer
City/Province
Your answer
Postal Code
Your answer
Birthday
MM
/
DD
/
YYYY
Primary Phone Number
Your answer
Alternate Phone Number
Your answer
Email
Your answer
CHILD # 1 Name - if required
Your answer
Age of Child
Street Address:
Your answer
City/Providence
Your answer
Postal Code
Your answer
Birthday
MM
/
DD
/
YYYY
Primary Phone Number
Your answer
Alternate Phone Number
Your answer
Email
Your answer
CHILD #2 Name - if required
Your answer
Age of Child
Street Address:
Your answer
City/Providence
Your answer
Postal Code
Your answer
Birthday
MM
/
DD
/
YYYY
Primary Phone Number
Your answer
Alternate Phone Number
Your answer
Email
Your answer
CHILD #3 Name - if required
Your answer
Age of Child
Street Address:
Your answer
City/Providence
Your answer
Postal Code
Your answer
Birthday
MM
/
DD
/
YYYY
Primary Phone Number
Your answer
Alternate Phone Number
Your answer
Email
Your answer
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