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You may fill out this form online, print and mail in your pre-registration fees.
 Please refer to and print the appropriate Samboree page for full Samboree fees, information, contact methods and future reference.
Make check payable to: Louisiana Samboree
Mail form to:
Marcia Dial, 120 Chestnut Blvd, Pineville, LA. 71360

Which Samboree are you registering for?: Spring  Fall 
What is your anticipated date of arrival?:
First Name (his & hers) Last Name
Street Address
City
State/Province Zip/Postal Code Home Phone
E-mail
Your confirmation information will be sent via email.
Enter your Good Sam member number:
Expiration date:
Enter your chapter name.
Are you registering as an 'At Large' member?
Yes No
Is this your first Samboree? Yes No 
Is this your first Louisiana Samboree? Yes No
Enter children's names & ages (under 18-no charge).

Please refer to the appropriate Samboree page for fee amounts and offerings to be entered below!
Enter your Samboree fee: 
Enter the amount for each additional person over your rig fee:

Enter your At Large fee if you are registering as an At Large member:
Enter any other fee(s) that is(are) offered: Other fee(s) description:
Enter the total fees included with this pre-registration form:


By your signature you understand and you agree to abide by the terms and conditions indicated below.
I/WE understand the Louisiana Good Sam Organization has taken reasonable and necessary precautions and, therefore,
I/WE accept full responsibility for the welfare of my/our unit while attending the above indicated Louisiana Samboree.
The Louisiana Good Sam Organization reserves the right to refuse registration and/or admittance to anyone.

Signature___________________________________________________________ Date_____________

  Copyright 2004 Louisiana Good Sam. All rights reserved. Revised: 11/11/05