Lords Knights Mar 19

Pre-Registration
Deadline is
Friday, May 10 th
PLEASE PRINT CLEARLY
PERSONAL INFORMATION
MAY 17 – 19, 2019
MARIPOSA COUNTY FAIRGROUNDS
PRE-REGISTRATION FORM
EFFECTIVE 5/11/2019,
REGISTRATION WILL BE $15
PER PERSON, AND $10 PER
YOUTH, PAYABLE AT
MARIPOSA.
NAME: CMA #:
NAME: CMA #:
CHILD: AGE: CMA #:
CHILD: AGE: CMA #:
CHILD: AGE: CMA #:
CHILD: AGE: CMA #:
ADDRESS:
CITY: STATE: ZIP: PHONE:
CHAPTER NAME:
CHAPTER NO:
MANDATORY GROUNDS FEES (EVERYONE PAYS) NO. OF PERSONS ___________ X $8 = $ ____________
PRE-REGISTRATION FEE
NO. OF PERSONS
ADULTS (CMA MEMBERS) X $10 = $
CHILDREN/YOUTH (AGES 4-17) X $5 = $
OR FAMILY RATE (2 ADULTS AND 2+ CHILD/YOUTH) X $30 = $
CHILDREN (UNDER AGE 4) X $0 = $ 0
1 ST TIME GUESTS OR 1 ST TIME CMA MEMBERS X $0 = $ 0
MEALS
SATURDAY “KICK START” BREAKFAST W/SAUSAGE X $2.50 = $ ________________
CHILI COOK OFF DINNER ON SATURDAY
FREE
LADIES LUNCHEON ON SATURDAY ` X $6.50 = $ ________________
SATURDAY EVENING DESSERT X $2.50 = $ ________________
ON-SITE CAMPING (Fri & Sat Nights only)
(See Info Sheet for extra nights) NO. OF PERSONS NO. OF NIGHTS
TENT CAMPING FEE – ADULTS
TENT CAMPING FEE – CHILD/YOUTH (AGES 4-17)
________________
________________
X
$5 X _________ = $ ________________
X
$3 X _________ = $ ________________
RECREATIONAL VEHICLE SITE Per Rig $30 X _________ = $ ________________
QUESTIONS? CONTACT: LARRY SCAMARA, NCCMA STATE COORDINATOR
GRAND TOTAL: $_________________
PHONE: 209-768-2471 EMAIL: LSCAMARA@SBCGLOBAL.NET MAKE CHECKS PAYABLE TO NCCMA
MAIL TO: BRANDT CLARK, P. O. BOX 644, COARSEGOLD, CA 93614