Distance Running Camp - Family Discount Form

To receive the family discount, you must have two or more members from the same family attending the Luther College Distance Running Camp.

* = required field

NOTE: Campers MUST have proof of health insurance (copy of insurance card) provided to Luther college before check-in in order to participate in our camps.
1. First name*
Last Name*
Grade next fall*
School*
Gender*
Age*
Birth date*
Camper's cell phone
Camper's e-mail
Preferred roommate (one name only)
Adult T-shirt Size*
Attending as*
___________________________________________________________
2. First Name*
Last Name*
Grade next fall*
School*
Gender*
Age*
Birth date*
Camper's cell phone
Camper's e-mail
Preferred roommate (one name only)
Adult T-shirt size*
Attending as*
____________________________________________________________
3. First Name
Last Name
Grade next fall
School
Gender
Age
Birth date
/ /
Camper's cell phone
Camper's e-mail
Preferred roommate (one name only)
Adult T-shirt Size
Attending as
_______________________________________________________
Refund Policy: Written or e-mailed cancellation notice that is received five or more business days prior to the first day of camp will result in a full refund, less a $50 cancellation fee.
Payment Amount*
Family address*
City*
State*
Zip code*
Home phone
Parent's cell
Parent's e-mail*
Payment Method
Credit Card Type*
Credit Card Number*
Expiration Month*
Expiration Year*
Name as it appears on card*
Billing Street Address*
Billing City*
Billing State/Province*
Billing Zip/Postal Code*
Billing Country