Saint Nicholas Ranch & Retreat Center
Spring Family Camp Memorial Day Weekend May 27 - 30, 2016 First Name: _____________________________________ Last Name:__________________________________ Address:____________________________________________________________________________________ City: __________________________________________ State: _____________ Zip: ______________________ Home Phone:_______________________________
Cell Phone: ____________________________________
Email: _____________________________________________________________________________________ Select Room Package: ____ Family Lodge Room ____ Additional Room ____ Family Dorm Room ____ Extra Night ____ Single Lodge Room ____ Couple Lodge Room
$365.00 (3 - 4 persons; $30 for each subsequent family member) $70.00 (Number of additional rooms:____ ) $380.00 (2 – 6 persons; $30 for each subsequent family member) $70.00 per Room $150.00 (1 Adult) $300.00 (2 Adults)
Number of people: Adults: __________ Children (6 – 17): _____________Under 6 (No charge): ________________ Requested Lodging (Rooms assigned on a first come, first served basis): Lodge Room: ______________ Dorm Room: _________________ Payment: Check (Please make check payable to: St Nicholas Ranch) Credit card number (VISA or Mastercard): ______________________________________________________ Expiration Date: ____________ 3 digit code: __________________Mailing Zip code: ___________________ Name on Card: ______________________________________________ Amount To Charge:_____________
Mail payment and this form to: Saint Nicholas Ranch, P.O. BOX 400, Dunlap, CA 93621 Phone: (559) 338-2103 E-mail:
[email protected]