Make your own free website on Tripod.com

Louisiana Samboree Pre-Registration Form
Pre-Registration rates are subject to cut-off date displayed on Samboree page
RETURN TO HOME PAGE
Make check payable to : Louisiana Fall Samboree
Mail this form and check to: Jo Ann Coffey, 5221 Benjamin St., Alexandria, La. 71302

Please indicate which Louisiana Samboree you are pre-registering for:  

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
E-mail

Please indicate the # of items you are registering for:

AMNT  $

DESCRIPTION

 

Is this your first Samboree? Yes No           Is this your first Louisiana Samboree? Yes No

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