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MAN. & N. W.ONT SAMBOREE
AUSTIN, MANITOBA
Printable application form

Print form, fill it out, include cheques made payable to
MAN. GOOD SAM.

Mail to: Sharon Burke, 6 - 96 Stradford St., Winnipeg, MB R2Y 1T7
PH: 204-837-5388 E-mail address barshar@mts.net


Name: _________________________________________Spouse_________________________

Address: ___________________________________

City: ____________________ Prov/State:_________ P.C/Zip: ________

Good Sam # ________________________Exp: ___________

Chapter Name :___________________________ _____________

Additional Guests: ___________________________# Children ____________________Children's Ages.___________

Rig: M/H____________ 5th________ T/T/_____________ Length____________# Slides_______________

Early Bird : June 1, 2010_____________ Handicap Parking_________________

The undersigned accepts full responsibility for the welfare of their unit and persons within their unit while attending the Man & NW Ont Provincial Samboree and hold harmless the Man & N W Ont Provincial Good Sam Organization for any claim for personal injury by members or damage incurred to their unit. Signed: _____________________________ Date: ___________