MidLake 2015
May 22nd, 23rd and 24th
Devils Head Resort 56330 Bluff Road Merrimac, WI 53561
Registration Form
Teens for 4 to a room $150.00 --$135.00 before May 1st
Sponsors for 2 in a room $193.00 --$178.00 before May 1st
Sponsors for 1 in a room $282.00 ---$267.00 before May 1st
No Registrations will be accepted after May 10th.
Name:_____________________________________________________________________________
Gender
[ ] Disability/Special room needs: I request a room that is on the same level as the Midlake events
Address:_____________________________________________________________________________________
Name of Parent/Legal Guardian:_________________________________________________________________
Phone #:______________________________________________________________________________________
24 hour emergency contact:_____________________________________________________________________
Phone #:______________________________________________________________________________________
I am a :
-
Sponsor Sponsor ID #_______________________________
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Teen
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Certified life guard and am willing to volunteer at the pool.
My Sponsors Name:________________________________ Group:___________________________________
Roommate Names Group Rmmates ph #Sponsors Name
1)____________________________________________________________________________
2)____________________________________________________________________________
3)____________________________________________________________________________
Please Circle:
Tshirts: $15 each Hoodie: $35.00
Small Medium Large Extra Large
Send this form along with your check or money order for convention cost and t-shirt payable to MidLake 2015
3726 Bridge St Nw PO Box 206
Saint Francis, MN 55070
Phone # 612-889-8965
Email: evekaldahl@gmail.com |