LONG DISTANCE PICNIC 2012 Registration Form August 24, 25 and 26)
Norway Pointe, 5089Norway Beach Road, Hinckley, MN 55037
LIMIT is 215 persons. Registrations are on a first come, first serve basis only. Applications without payment will not be accepted. After 240 people, registration will be closed. Act now! Registration opens June 20nd and closes Aug 1st . Last date for cancellation is Aug 1st. Only pre-registered and paid members will be allowed to attend. The organizing committee reserves the right to assign cabins. You will be required to comply with all the rules of the State Park. The Samaj will make all possible arrangements within reason. Everyone must sign a liability waiver before entry will be permitted.
Registration Form Names of all family members coming (provide children’s ages) Names
Ages (child)
Payment Amount
Total Members Fees 3 Days/2 Nights : $25 per person Children under 5: $10 per child
1 Day (Saturday only) : $15 per person Children under 5 : $5 per child
NON-Members Fees 3 Days/2 Nights : $50 per person Children under 5: $20 per child
1 Day (Saturday only) : $30 per person Children under 5 : $10 per child
Primary e-mail: ______________________________________________ Contact number: ___________________________________________ (Updates will be communicate by e-mail for this event)
Signature Your registration is complete only when we receive this form and advance payment. Mail payment and fully completed form to:
Mail the form and payment to : KAUSHAL AMIN, 7810 EVEREST CT N, MAPLE GROVE, MN 55311