MAIL TO

Rich Falk Basketball Camp
P.O. Box 201
Glenview, Illinois 60025

Phone:  (847) 205-1667

Today’s Date:                            

Recommended by:                                                  

__    Resident Camper:  $500 ($100 Deposit)

__   Commuter Camper:  $450 ($100 Deposit)

PLEASE ENROLL THE FOLLOWING CAMPER FOR 2011

July 17-21

(ENCLOSE $100.00 DEPOSIT)

Name:                                                                                 Age at Camptime             

Home Address:                                                                                

City, State, Zip:                                                                                 

Phone Number: (                   )                                                          

Parent's E-Mail Address                                                                           

School Next Year:                                           Grade Next Year:               

Previous Camper at Rich Falk Basketball Camp:    __ Yes   __ No

Roommate Preference (request only one)                                                                                   

Friends or groups may request rooms near one another

Consenting Parent or Guardian Signature:                                                                                   

__ Please send                     additional brochure(s) for my friend(s).

NOTE: THIS CAMP IS NOT A FUNCTION OF TRINITY INTERNATIONAL UNIVERSITY.

Note:  We are expecting a full camp and enrollment is limited.  Any balance due (less your deposit) is not required until the first day of camp at registration.  Even with advance notice, $25 of deposit is non-refundable due to pre-camp reservation and administrative costs.  If this camp is filled when your application is received, your total deposit will be refunded.  If you cancel on or after Sunday (first day of camp), the $100 deposit is non-refundable.