Waitts Lake Camp >Application Form

* Fields marked with a red asterisk are required.

Waitts Lake Camp Application
* Name of Group:
* Address of Group:
* City:
* State:
* Zip:
* Phone:
Fax:
Name of Parent Organization:
Website:
* Mission Statement of your Organization:
* What is the purpose of your proposed retreat?
* What will be the theme of your program?
* Is your organization nonprofit?       Yes       No
* Expected number of attendees by category. You must place a number in each box even if it is a "0" for attendance. Children (0-11):    Youth (12-18):    College:    Adult:    Seniors:    Total:
* List dates that you would like to have your retreat:
* Name of person filling out this application:
* Address:
* City:
* State:
* Zip:
* Email:
Fax:
Home Phone:
Work Phone:
Cell Phone:
Title/position with the above group/organization:
Comments or Questions: