Registration Form

 

Dads, Lads & Gals

 

Rockfish Camp & Retreat Center

 

226 Camp Rockfish Rd. Parkton, NC 28371

 

l-910-425-3529

Fax: 910-875-6177 • E-mail: info@RockfishOutdoorCenter.org

Family_____________________ How many children? M____ / F____
Phone #: (__)________________ Work #: (__)___________________
Street Address:_____________________________________________
City:____________________________ State:_____ Zip:____________
E-mail:____________________________________________________
Shelter Request: Cabin___ Treehouse___ Yurt____

You can also bring your own tent.

 

Card Number ___/___/___/___-___/___/___/___-___/___/___/___-___/___/___/___

 

Expiration Date: __/__ Security Code_ _ _

Please Circle: Master Card or VISA Cardholder's billing address (if different): _______________________

City:___________________ State:________ Zip:__________

I give permission for my credit card to be charged the amount of $_____ (full payment of registration fee is required).  I have read and understand the cancellation and refund policies as described in the information above.

Signature of cardholder:_______________________ Date:___ /___/___

Mail this registration form to Camp Rockfish. Remember to include a check and money order. Please make checks out to Camp Rockfish and mail to Camp Rockfish, 226 Camp Rockfish Rd., Parkton, NC 28371. Fax: 1-910-875-6177

For credit card payments call (910) 425-3529