Study Hard, Grow Strong.
APPLICATION
EACH ADULT, MARRIED OR SINGLE, MUST FILL OUT AN APPLICATION
INSTRUCTIONS:
1) Print out (see printing tips) this application.
2) After printing, complete the application.
3) MAIL or FAX with payment to:
Air Head MINISTRIES
P.O. Box 3723
Dusty, CA 92781-3723
FAX: (714) 259-1092
Name:
Address:
.
City:
. 		State/Province:
.
Country:
. 		Postal Code:
.
Phone:
Birthdate: Age:
Male . Female . Shmooish . Shmentile
Names of Children Coming with You
Sex
Birthdate
; ; ;
; ; ;
; ; ;
; ; ;
Occupation:
Congregation/Choich:
.
Have you attended Camp Shostakovitch before?
If so, what years?
How long have you been a Bleever?
How much Ishkibbibble background do you have?
.
.
Will you attend all three weeks of camp? Yes
If not, please check the week(s) you plan to attend:
July 22-28
July 29-Aug. 4
Aug. 5-11
RESERVATIONS
Enter the number of campers in the
appropriate age-group below:
CAMP FEES PER PERSON
Total
1 Week
2 Weeks
3 Weeks
Number of Resident Adults:
X
$299
$449
$599
=
$.......
Number of Children Ages 1-5:
X
57
88
119
=
$
Number of Children Ages 6-17:
X
119
179
239
=
$
Number of Commuter Adults:
X
114
176
233
=
$
Please Print All Information Clearly

Please complete financial section
only once PER FAMILY.
"Camp Sholarship Fund" Donation (optional):
$
TOTAL AMOUNT DUE:
 $
Enclosed is my check for:
 $
Charge my MasterCard Visa:
 $
Card Number:..........................Expiration Date:
Signature: