NORTH DAKOTA 2009 SAMBOREE
REGISTRATION FORM AUGUST 19-23, 2009,
TAKE
A TRIP WITH A GOOD SAM CHAPTER!
Our Samboree will include
entertainment, door prizes, goodie bags, raffles, seminars, breakfast, coffee
& cookies, games, vendors, flea market, craft tables, pot luck supper
Tuesday night (bring covered dish to share and your own eating utensils),
banquet (optional), and tours.
NOTE:
DRY CAMP,
EXCEPT FOR MEDICAL NEEDS.
All persons in each rig must come to registration to receive their wrist
bands. Emergency telephone number is
911. Please do not send registrations after Aug 15, we spend Samboree week
at the Samboree and are not home to receive them. Walk-ins must register and pay day fees of
$8.00 per person. Saturday day passes to
include the entertainment are $10.00 per person. Early bird fees start Monday night. Aug
17.
= = = = = = DETACH LOWER PORTION AND MAIL,
RETAIN UPPER FOR DIRECTIONS = = = = = = =
NAME:
___________________________________________ SPOUSE:
_________________________________
EXTRA ADULT NAME(S) FOR TAGS
______________________________________________________
CHILD/TEEN/GRANDCHILD NAME(S)
FOR TAGS ____________________________________________
GOOD SAM #____________________ EXP DATE ________________ PHONE _____________________
ADDRESS
_________________________ CITY _____________________ STATE/PROV __________ ZIP _________
EMAIL ADDRESS
___________________ HANDICAP REQ YES /__/
(MUST HAVE STICKER) ELEC YES
/__/
UNIT TYPE __________________________
LENGTH
______________________ LICENSE
_____________
TOWED VEHICLE TYPE
________________________ LICENSE ___________________
CHAPTER NAME _________________________________ STATE
_________________________
IS THIS YOUR 1ST
SAMBOREE NO /__/
YES /__/ FIRST ND SAMBOREE ATTENDED NO
/__/ YES /__/
SAMBOREE FEE ($50.00) 2 ADULTS 3 NIGHTS
CAMPING + 2 Free Breakfasts Ea $______
($40.00) 1 ADULT 3 NIGHTS CAMPING + 2 Free Breakfasts
$______
AFTER AUG 1, 2009 ($55.00) 2 ADULTS 3 NIGHTS CAMPING + 2
Free Breakfasts Ea $______
($45.00) 1 ADULT 3 NIGHTS
CAMPING + 2 Free Breakfasts $______
ADDED FAM MEM ($10.00) PER PERSON includes 2 Free
Breakfasts $______
CHILDREN UNDER 12 FREE
EARLY BIRD FEE ($7.00) PER NIGHT PAYABLE AT
REGISTRATION $______
BANQUET SAT EVE ($10.50) PER PERSON PAYABLE WITH
REGISTRATION $______
TOTAL ENCLOSED (
Processing fee for
cancellations is $5.00 prior to Aug 15, 2009; no refunds for cancellations
received during the week of the Samboree.
MAKE CHECKS PAYABLE TO:
DON STRUBE, Treasurer 701-838-2388
MINOT, ND 58701
I, the undersigned, accept
full responsibility for our unit and all persons in and out of our unit while
attending the North Dakota Samboree, and hold the North Dakota Good Sam Club
and its designated officials blameless for any claims for personal injury or
damage to any camping or driving unit.
SIGNATURE_______________________________
DATE___________________
CHECK OUR WEB SITE FOR FUTURE UPDATES AND MORE
DETAILED INFORMATION REGARDING SEMINARS,