CAMP NE-O-TEZ MEMBERSHIP REGISTRATION FORM - 2008

 Please return this with your annual dues to Camp Ne-O-Tez,  3761 Three Oaks, Bridgeton, MO  63044

E-Mail Address:___________________________________________________________________________

Name:  __________________________________________________________________________________

Address:  ________________________________________________________________________________

City: __________________________________  State: ______________ Zip: ______

Telephone: _____________________________

Congregation: _______________________________________

Check one:  € $100.00  €  $50.00  € $25.00  € $12.50 (SENIOR/STUDENT)    

Additional Gift $ ________

Polo Shirt unless you Circle Denim Shirt or Wind Shirt ($100 membership) 

CIRCLE SIZE   Small   Medium   Large   X-Large   2X-Large  (all adult sizes)

Mastercard/Visa/ Discover Card Number: ____________________________

Expiration Date: _______________