PAYMENT INFORMATION

Total Transaction Amount *

$

My payment is for:*

Camp Akita - Capital Camp Akita - Kabins 4 Kids Camp Akita - Operating Donation-Other, See Comments Fees-Adventurers* Fees-Camp Meeting* Fees-Mens Retreat* Fees-Pathfinders* Fees-Seniors Retreat* Fees-Womens Retreat* Fees-Other, Details in Comments DESCRIPTION

Items in DESCRIPTION list above marked with 
* are not tax-deductible items.

 PERSONAL INFORMATION

First Name/Last Name*

Address*

City*

State*

Illinois Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Indiana Iowa Kansas Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code*

 Country*

Phone*

Area Code/Number

E-mail Address*

COMMENTS or Additional Information:

* REQUIRED