Camp Endres Family Camp November 1 -3, 2019 - More information coming soon! Day Hour Minute Second Registration Info You can pay the normal (subsidized) amount, or cover the actual cost per camper, or make a partial payment (minimum $25), or request a scholarship.Pay $25 registration fee and pay the remaining balance later*No charge for ages 4 and under. Price: $25.00 Quantity: Pay $25 registration fee and apply for a scholarship*No charge for ages 4 and under. Price: $25.00 Quantity: Pay the camper fee – amount charged per camper*No charge for ages 4 and under. Price: $96.00 Quantity: Pay the actual camper cost – how much DSOK must raise to pay for each camper*No charge for ages 4 and under. Price: $150.00 Quantity: PriceWould you also like to make a donation? Enter an amount below. Total $0.00 Camper InfoFamily Camp Attendees*DOB= Please list date of birth for all children, not parents T1D= Please identify which family member has type 1 diabetes Family Member (1, 2, 3, etc.)First NameLast NameT-Shirt SizeDOBT1D Parent/Guardian InfoYour Name* First Last Your Phone*Your Email* Payment InfoBilling Address*Please enter the billing address for the credit card. Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name
