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Registration and Payment

L.E.A.D. Registration 2010

Please fill in the following REGISTRATION INFORMATION as completely as possible: Email any questions to: leadcamps@comcast.net or you can call 609-937-4117 and speak to David May - Director of L.E.A.D. Camps.

First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Daytime Phone:
Evening Phone:
Email:
Date of Birth:
T-Shirt Size (S-3XL):
Grade Level:
Coach/Teacher/Director:
Your Position or Title:
Parent/Guardian First Name:
Parent/Guardian Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Phone / Cell Phone:
Emergency Contact First Name:
Emergency Contact Last Name:
Emergency Phone:
Physicians Name:
Physicians Phone:
Hospital Affiliation/Preference:
Daily Medications:
Medical Allergies:
Food Allergies:
Other Allergies:
Chronic Medical Conditions:
Medical Insurance/ HMO #:
Any other comments or notes:

$195.00

The L.E.A.D. Camp fee of $195.- is all inclusive of meals, equipment & camp resources and cabin lodging. This includes lunch on 7/20 through breakfast on 7/22 along with fruits, snacks, and beverages. Facilities include separate male and female cabins with private showers and restrooms, individual bunks, a personal LEAD resource manual and a L.E.A.D. T-Shirt.

Payment by check can be made out to: DTM MUSIC, INC. and mailed to:

L.E.A.D. CAMP c/o

DTM Music, Inc.

217 Peach Road

Edgewater Park, NJ 08010