Please provide the following contact information:
First Name(s) Last Name Chapter Name & Number Street Address Address (cont.) City State/Province Zip/Postal Code Good Sam # & Expiration Date Home Phone
Please indicate the # of items you are registering for:
Is this your first Samboree?
No Is this your first Louisiana Samboree?
Enter your attending children's names and ages in the space provided below (no extra fee if under 18).
I/WE understand the LA Good Sam Organization has taken reasonable and necessary precautions and, therefore, I/WE accept full responsibility
for the welfare of my/our unit and all persons in my/our unit while attending the Louisiana Good Sam Samboree.
Signature ____________________________________________ Date ____________________ Check # ___________________
THE LOUISIANA GOOD SAM ORGANIZATION RESERVES THE RIGHT TO REFUSE REGISTRATION AND/OR ADMITTANCE TO ANYONE.
Copyright © 2004 Louisiana Good Sam. All rights reserved. Revised: July 02, 2004