Registrar's use only
StatA2
StatB2

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First Name*


Last Name*


Name on Badge (if you leave blank, we use first and last name)


Gender* (check one)
Male
Female
Other/non-binary

Check this box to copy Camper 1 address info to Camper 2

Street Address*


Zip/Postal code* (Entering the Zip code populates City and State. Make sure those are also correct)


City*


State/Territory/Province*
Select from the following list Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Armed Forces Americas Armed Forces Others Armed Forces Pacific Federated States of Micronesia" Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico United States Minor Outlying Islands Virgin Islands Alberta (Canada) British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Not in list - enter in Country field


Country (if not United States)


Check this box to copy Camper 1 phone info to Camper 2

Telephone* (enter at least one; will format as xxx-xxx-xxxx)

Day	Type Select one Home Work Mobile Other
Evening	Type Select one Home Work Mobile Other
Preferred contact number?	Select one Day Evening

Email Address*


Sleeping Accomodation* (check one)
No preference
Women only
Men only
Co-ed
Families with kids
Motel (or other offsite)
Car/RV
Platform tent (contains cots for up to 5; limited spaces available)
Private tent (limited spaces available)
   (For private tenting, help us manage small vs and large tent locations)
   Tenting Alone With:
     

Include my information on the camper roster EXCEPT for
Name (check Name to exclude everything)
Street address
City/state/zip/country
Day phone
Evening phone
Email

YES! Please share my information with other organizers/events.

Registration Type*(check one)
   (prices based on postmark or transmission date):
Adult ($320 until June 27, $340 after)
Adult Tent/RV/motel ($300 until June 27, $320 after)
Youth under 30 ($245 until June 27, $265 after)
Teen 10-18 yr-old ($80 until June 27, $90 after)
Child 2-9 yr-old ($50 until June 27, $60 after)

Special camp fee
(Note: you MUST specify a Registration Type above even if using this, and you MUST add a note in Comments below as per Registrar's instruction. DO NOT USE without prior discussion from the Registrar.)
   $

I would like to make a tax-deductible donation to PCDC for
   $

Amount due for this camper $

Dietary Preferences (check all appropriate and at least one)*
Omnivore - I enjoy both meat and veggies
No red meat - I eat veggies, fish, and poultry
Vegetarian - I eat veggies, but no meat, fish, or poultry
Vegan - I eat only veggies, no meat, eggs, cheese, etc.
Dairy-free
Gluten-free

List any other dietary restrictions, allergies, etc. we should be aware of (optional):

Comments - elaborate on any of the above, or add additional information about this camper. Let us know if we missed anything, or there is something else we should know (optional):