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Barn Dance Historical Society, P.O. Box 68 Wingham , ON N0G 2W0

REGISTRATION for the 21st Annual Jamboree/Campout Weekend

May 24, 25, 26, and 27th, 2018

Blyth & District Community Complex and Campgrounds,
377 Gypsy Lane, Blyth, Ontario

Name(s)……………………… ……………………………… ………………………………

Address…………………………… ……………………City/Town……… ……………………………….

Postal Code………………………….. Telephone Number [……….]…………………

RV License Plate#………………………… ………. Membership #(s)………………………… …………..

# of Persons in Party . _______
Camping on Wednesday _____Thursday _____Friday _____Saturday _____ Sunday ______.
NOTE: FOUR NIGHT CAMPING RATES CAN BE WEDNESDAY TO SATURDAY OR THURSDAY TO SUNDAY NIGHTS

I would like to volunteer as a helper ______.

NON MEMBERS:

Admission to all Events & Camp Site Included
1 Non Member
2 Non Members
TOTAL
 Sat Night Camping & Events
 $78.00 
 $116.00 
$   
 Camping 2 Nights & Events 
 $118.00 
 $166.00 
$   
 Camping 3 Nights & Events 
 $148.00 
 $196.00 
$   
 Camping 4 Nights & Events 
 $178.00 
 $226.00 
$   
 * Extra Arm Bands All Events
 Number _______
 @ $50.00 each 
$   
TOTAL
 
  
$   

MEMBERS ONLY - Must have a current membership card and number shown above or pay membership fee below.

Admission to all Events & Camp Site Included
1 Member
2 Members
TOTAL
 Sat Night Camping & Events
 $73.00 
 $109.00 
$   
 Camping 2 Nights & Events 
 $100.00 
 $136.00 
$   
 Camping 3 Nights & Events 
 $127.00 
 $163.00 
$   
 Camping 4 Nights & Events 
 $154.00 
 $190.00 
$   
 Extra Arm Bands* For 
 Members – Number_____
 @ $40.00 each 
$   
 Extra Arm Bands* For Non 
 Members – Number_____
 @ $50.00 each 
$   
Sub - total
    $  
 Membership Fee(for 1 year)
 If not previously paid
  Single $25; Dual $40
$   
 TOTAL Paid 
  By May 4th
  
$   

Email address for Registration Confirmation _______________________________________________ ______________________

Handicapped Site Requested (15 Amp Service only - Smaller units) Permit # _____________
All Prices include HST (13%) - Members must show Membership Number for each Extra Armband(s).

Make cheques payable to “Barn Dance Historical Society”; Box 68, Wingham, ON N0G 2W0

Cancellation Policy: We will refund your money if you cancel prior to May 4th, less a $20 admin fee.

NO POST DATED Cheques. Returned cheque Fee - $25.00;

ADMISSIONS AT DOOR: Weekend Armband - $50/person; Friday Evening Event - Arm band - $15.00.
Saturday Evening Show/Dance Arm Band - $30.00 Sunday Gospel Show Arm Band - $10.00(HST included)

BLYTH LIONS CLUB

SATURDAY EVENING DINNER AND SUNDAY MORNING BREAKFAST TICKETS
ORDER FORM - 2018

CHEQUES PAYABLE TO “ BLYTH LIONS CLUB

 Saturday, May 26th – 4:00PM – 6:30PM – Dinner Tickets (Buffet style, includes desserts and coffee/tea)

 Number of Dinner Tickets_____________________ @ $17.00 each $______________

 Sunday, May 27th – 7:30AM – 9:30AM - Breakfast

 Number of Breakfast Tickets_________________ @ $7.00 each $______________

 TOTAL - - - - - - - - - - - - - - - - - - - - - $______________  

Name________________________________________________________________

  Address______________________________________________________________

City/Town_____________________________________Postal Code______________

ADVANCE TICKETS ONLY. Enclose your cheque payable to "Blyth Lions Club" with your Barn Dance Registration. Your tickets will be issued with your registration.

NOTE: If you make your cheque payable to the Barn Dance Historical Society, PLEASE ADD 13% HST to your order.