Name(s) 
Address 
City  State  Zip 
Phone: home  work   
	   Best time to reach you? 
email  
FEE:





Weekend Fee
Sliding scale $140 - $180
$ 
x (#adults)
= $  (a)



1st Child under 14
$50
x (#children)
= $  (b)



Additional children under 14
$35
x (#children)
= $  (c)



Teens 15-17
$90
x (#teens)
= $  (d)




Indoor cabin space
(not guarenteed, will will confirm)
$15
x (#adults/teens/)
= $  (e)



Optional Scholarship donation
= $  (f)




Total Due: (a thru f)
= $ 





Enclosed (check one)
 Total due
	

	  Scholarship application attached







Payment via
 PayPal 
	

	  Check







Make checks payable to Earth Drum Council.

Please help us by giving us the following information:

Food preference:  dairy;  non-dairy 
		(If you leave blank, we count you as dairy)




Earth Drum Council reserves the right to ask any participant to leave
the event without a refund if his/her behavior is disruptive to the 
event. I understand that neither Earth Drum Council nor Camp Hi-Rock 
and its management is responsible for personal injury or loss of
property during this event.

(signed) ____________________________________ (date) _____________
No registrations will be accepted without signature. Each adult
registering must sign.
------------------------------------------------------------------------
To register, please print this form, complete it, and mail it with your
deposit to: Earth Drum Council, PO Box 1284, Concord, MA 01742 USA
Questions? Contact us at (978) 371-2502 or by e-mail at edc@earthdrum.com