Scandia Camp Mendocino
June 15-22, 2002

Application

Name (s)   _________________________________________

                  _________________________________________

Address (es) _______________________________________

                     _______________________________________

Phone (s) ___________________   _______________________

Email address (es)___________________________   ___________________________

How would you like your name(s) to appear on your name badge(s)?

_________________________________  ________________________________

Please mark/check all that apply. I am/we are signing up as:

__ Single

__Couple

__Dancer(s) ($525 per person)

__Musician(s) ($525 per person):

    Please list instruments:____________________________________

__ Work Scholarship(s) ($300 per person)

__I am applying to Scandia Camp Mendocino for the first time, please enter me in the $50 discount drawing

I am enclosing $150 per person deposit. Total enclosed:____ Balance due:____

Make checks payable to Scandia Camp Mendocino, and mail with this application to:

Scandia Camp Mendocino, 393 Gravatt Dnve, Berkeley, CA 94705

Include 2 legal self-addressed, stamped envelopes plus this application.

__ Please keep/put me on the mailing list. __ Please remove me from the mailing list.

Please send information about Scandia Carnp Mendocino to:

__________________________________________________________________________________

Note: Scandia Camp Mendocino offers five $50 registration discounts to participants attending for the first time. A11 registrations from new Scandia Campers' received by January 15, 2002 will be put into a drawing for the discounts. Winners will be notified.