DIRECTOR INFORMATION
* Indicates items that are required.

Name*
  Prefix First Last
Home Address
  Street/Box Number
 
  City State ZIP/Postal Code
 
  E-mail Address* Home Phone*
 
  Work Phone Cell Phone
 
  Pager FAX
Best times to call (between) at home    work
cell       pager


(Assistant Director or other contact person)
Name
  Prefix First Last
Home Address
  Street/Box Number
 
  City State ZIP/Postal Code
 
  E-mail Address Home Phone
 
  Work Phone Cell Phone
 
  Pager FAX
Best times to call (between) at home    work
cell       pager
Questions/Comments:



CAMP INFORMATION

Camp Type* Ages of Campers*
Sponsoring Jurisdiction(s)
Campground/Location*
Camp Address*
Street/Box Number
City* State* ZIP/Postal Code* Phone*
Starting Date*
  Month Day Time
Ending Date*
  Month Day Time
Staff needs to arrive early for staff training yes     no
  If yes, when?
Special Needs (mark all that apply): Campfire        Counseling
  Recreation
  Other
I would prefer a female male  
  female or male more than 1 representative
Questions/Comments:
Best airport to fly into
Driving Directions
(from nearest airport/city)
When would be the most convenient time during the camp for the Graceland
Representative to give a presentation?
Questions/Comments:
Are there any special regulations, shots, or paperwork that Graceland Representatives
will need to comply with in order to attend your camp?*
Yes       No
If yes, what?: