Registration Form 2012 PLEASE FILL OUT AND PRINT
or cut and paste form into email
Name (to appear on badge):
Street Number:
City: State/Province:
Country: Postal Code:
Telephone Number:
Fax Number:
E-mail Address:
Gender: M F  Age, if under 18 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 +18
Roommate Preference (if any)
Emergency Contact Phone  
Smoker Non-smoker Early Bird Night Owl
Are you applying for a camp scholarship? (Application available on website)
I will attend Folk Dance Camp: First Week,   Second Week ,    Both Weeks
This will be my year at Camp
I will be interested in University credit (an additional fee required)
Fee Schedule: (per person, per week)
A. $850.00 Tuition, shared room and all meals
B. $930.00 Tuition, private room, and all meals
C. $465.00 Commuter camper (tuition only)
Add a $15 paper syllabus I will download the syllabus from Stockton's web page for free
Add a $10 per week linen fee I’ll bring my own linens
Enclosed is my deposit of $
Click HERE to make a payment using a credit card or PayPal account.
($75 per person per week due now, with an additional $225 per week due by May 15)
No deposit refunds after May 15, unless your position is filled by a person on the waiting list.
Make checks payable to: FOLK DANCE CAMP
IF YOU DON'T WISH to use the credit card/PayPal option above, you may ask us to manually
enter a payment on your Credit Card:
How much do you want charged to your card now?
Visa Master CardCard Number
Expiration Date 01 02 03 04 05 06 07 08 09 10 11 12 12 13 14 15 16 17 18 19 20
Name as it appears on the card:
Signature: _______________________________________________________