To assure your space at camp, please detach and fill out the application form and send it with a $100 deposit check (non-refundable) made payable to Bergey’s Wings Lacrosse Camp. Tuition must be paid in full by July 1st.

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Please fill out and print. When completed, please mail to: Bergey’s Wings Lacrosse Camp 2142 market st suite A102 Camp Hill PA 17011 *Also include $100 Deposit

Name:

Address:

City:

State:

Zip Code:

E-Mail Address:

Phone Number:

Age as of July 1st, 2009:

School/Team:

Years of Experience:

Roommate Request:

Position:

$450 Resident Camper

$350 Day Camper (8:30 am - 9:00 pm includes lunch and dinner)

$20 Family Discount Per Camper (2 or more family members)