1. Name: ______________________________________________________

2. Sex: □¨M  □          ¨ F                                                                       3. Age :                                                                          

4. Tel : Day                                                                  -                                                        -                                                                                           Night                                                             -                                                                -                                                                                                

                 Fax :                                                                         -                                                            -                                                                                                           E-mail:                                                                                                                                                                                                                                                                                                                                               

5. Address :                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                

6. Emergency Contact Person: Name                                                                                                                                                                                                               　       　　                         Relation    　　                                                                                                                                              　　

Tel: Day                                                                     -                                                          -                                                                                                            Night                                                     -                                                                 -                                                                                                 

7. Relatives in Adult Group? □        ¨Y □                       ¨N                                   Name                                                                                                                                                                                                                                                    

I will attend :                                                                Days                                                                     Nights                      From 7/                                          To 7/                             

I need a hotel room :                                                              Days                             From 7/                                 To 7/                                            

¨□ I need transportation to the campsite. Flight arrival information:____________________________________

¨□ I will arrange my own transportation to the camp site.

¨□ I need directions to the hotel

1. Phobia (such as darkness, strangers):                                                                                                                                                                                    
2. Illness needs attention:                                                                                                                                                                                                                                                                               
3. Allergies:                                                                                                                                                                                                                                                                                                                                                                  
4. Others:

1. Please read the flyer before applying.

2. The application form is only for each individual.

3. Space is limited, please submit this form ASAP.

□ Check enclosed: Check # _______________  Total amount: $________________ 

Names of participants included in the check: ____________________________________________________