Please fill in this from to begin the camp registration process. Once you submit this form, you will be contacted with additional information within a few weeks.  If you have any questions about this form, please contact Ben Spong 304-293-9425

First Name

Last Name

Street Address

Address Line 2

City

County

----------------------- --Select County-- ----------------------- Barbour Berkeley Boone Braxton Brooke Cabell Calhoun Clay Doddridge Fayette Gilmer Grant Greenbrier Hampshire Hancock Hardy Harrison Jackson Jefferson Kanawha Lewis Lincoln Logan Marion Marshall Mason McDowell Mercer Mineral Mingo Monongalia Monroe Morgan Nicholas Ohio Pendleton Pleasants Pocahontas Preston Putnam Raleigh Randolph Ritchie Roane Summers Taylor Tucker Tyler Upshur Wayne Webster Wetzel Wirt Wood Wyoming ----------------------- Outside WV

State

----------------------- --Select State-- ----------------------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Maine Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming ----------------------- Outside Canada US

Zip Code

Phone Number

Parent or Guardian

Email Address

I am interested in receiving a scholarship to attend camp

I have a scholarship to attend camp. I will be sponsored by: (please list)

How did you find our website? Search Engine Friend Agency Link Sponsoring Organization Facebook WV Family Magazine Other

Enter security code: