Shri Kripaluji Maharaj

Memorial Day Weekend Retreat, May 2017
Registration Form

To register yourself and your family for the Memorial Day Weekend Retreat, May 2017, please fill out the form below.

You must provide information for the fields marked with an asterisk (*).

1. Attendee #1 (Primary Contact)

First Name: *
Last Name: *
Gender: *  
Age Group:  
Street Address: *
City: *
State: *
Zip/Postal Code: *
Country: *
     
Email: *  
Cell Phone:   (At least one phone number is required)
Home Phone:  
     
Date of Arrival: *
Date of Departure: *
     
     
Like to be a volunteer?  

2.   (Click the checkbox to enter details of the second attendee)


Miscellaneous Info

Sponsorship Opportunities
How did you hear about the camp? *
Any comments? (up to 300 characters):  

Waivers

Please read the following waivers and click on the checkbox to indicate your acceptance.