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

REGISTRATION for the 20th Annual Jamboree/Campout Weekend

May 25, 26, 27, and 28th, 2017

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
 $68.00 
 $99.00 
$   
 Camping 2 Nights & Events 
 $105.00 
 $146.00 
$   
 Camping 3 Nights & Events 
 $132.00 
 $173.00 
$   
 Camping 4 Nights & Events 
 $159.00 
 $200.00 
$   
 * Extra Arm Bands All Events
 Number _______
 @ $45.00 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
 $66.00 
 $97.00 
$   
 Camping 2 Nights & Events 
 $91.00 
 $122.00 
$   
 Camping 3 Nights & Events 
 $116.00 
 $147.00 
$   
 Camping 4 Nights & Events 
 $141.00 
 $172.00 
$   
 Extra Arm Bands* For 
 Members – Number_____
 @ $32.00 each 
$   
 Extra Arm Bands* For Non 
 Members – Number_____
 @ $45.00 each 
$   
Sub - total
    $  
 Membership Fee(for 1 year)
 If not previously paid
  Single $25; Dual $40
$   
 TOTAL 
 
  
$   

Email address for Registration Confirmation _______________________________________________ ______________________

Handicapped Site Requested (15 Amp Service only - Smaller units) Permit # _____________

1. All Prices include HST (13%).
2. Continental Breakfast on Saturday Morning by donation.
3. * Extra arm bands for admission to all events available at time of registration ONLY. 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 6th, less a $20 admin fee.

No Post Dated Cheques. Returned cheque Fee - $25.00;

ADMISSIONS AT DOOR: Weekend Armband - $45/person; Friday Evening Event - Arm band - $10.00.
Saturday Evening Show/Dance Arm Band - $25.00 Sunday Gospel Show Arm Band - $10.00(HST included)

BLYTH LIONS CLUB

SATURDAY EVENING DINNER AND SUNDAY MORNING BREAKFAST TICKETS
ORDER FORM - 2017

CHEQUES PAYABLE TO “ BLYTH LIONS CLUB

 Saturday, May 27th – 4:00PM – 6:30PM – Dinner Tickets (Buffet style, includes desserts and coffee/tea)

 Number of Dinner Tickets_____________________ @ $17.00 each $______________

 Sunday, May 28th – 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.