90th Reunion Weekend Registration

September 1st - 3rd, 2018

Camper(s) Information

First Name
Last Name
Age
Additional Names
Age
Additional Names
Age
Additional Names
Age
Years at Ak-O-Mak
Maiden/nick Name at Camp:
Gender
Male Female

CONTACT DETAILS

Home Address: Street
City
Province / State
Country
Postal / Zip Code
Home Phone
Cell Phone
E-mail

Payment Information

Tuition: Adult $200.00 + HST = $226.00 each, Children 12 & under: $110.00 + HST = $125.00 each
PAYMENT Adult $226.00 x
Subtotal: $
PAYMENT Children $125.00 x
Subtotal: $
TOTAL   Total: $
Credit Card:
   
Card Number
Expiration Date (mm/yy)
Name on Card

I Confirm that the payment details above are correct and I authorize Camp Ak-O-Mak to use the above credit card for the tuition & any reconciliation of my account.

TERMS AND CONDITIONS

  • All camp fees must be paid in full with registration form. A $75.00 per person admin fee will be charged for cancellations before August 1, 2018. Cancellations after August 1, 2018 will forfeit registration fee with no refund.
  • All credit card transactions are final sales that cannot be disputed or subjected to a charge back.
  • I agree Camp Ak-O-Mak is released from liability in connection with medical treatment and unavoidable accidents. Camp Ak-O-Mak has my permission to use necessary medical measures in the event of an emergency.
  • Liability Release Waiver is required to be signed in advance or upon Check-In.
  • Enrollment is limited.

Business Office: 14-441 Stonehenge Drive, Ancaster, Ontario, Canada L9K 0B1,
Tel.: 416.427.3171, Fax: 905.304.2982
Email: Dianne@campakomak.com Website: www.campakomak.com

Summer Address: 240 Akomak Road, Ahmic Harbour, Ontario, Canada P0A 1A0,
Tel.: 705.387.3810, Fax: 705.387.0077