Q-CAMP Pay in Full Registration

Registration

All ready for Q-Camp ?

Well get this form filled out, submit your payment and you'll be set!

Still have questions? Email us at qcamp@qsquared.org

About You

First Name *

Last Name *

Mailing Address *

City *

State *

Zip *

Contact Phone

Email *

Q-Contact Page

We want you to stay in touch with the new friends you made. At the conclusion of Q-Camp we will be sending all attendees a contact page with the name of everyone who attended.

Please let us know what information you are okay with us sharing with the other attendees.

Uncheck anything you do not want us to include on the Q-Contact Page:

*

Include Your Last Name

Include Your Mailing Address

Include Your Phone Number

Include Your Email Address

Have you been to our event before? *

I discovered this event through: *

Other or Additional Information:

Getting to Q-Camp

Transportation *

I need a ride - please help me arrange a carpool.

I'll have to drive, but can take people with me.

I've made my own arrangements to get to Q-Camp.

Additional information: 🛈

Special Needs

Click on the "?" for more information about a topic!

Other Needs 🛈

I would like vegetarian meals.

I have special dietary needs.

I have other special needs.

Please describe/explain your special needs: 🛈

I would like to offer the following to Q-Camp:

Are you a nurse, doctor or EMT that would agree to be 'on call' for the weekend?

Yes

Payment and Authorization

Please choose the best option for your stay: *

Standard Room

Double Room is NO LONGER AVAILABLE-

Cabin Dorm

Day Tripper

Scholarship Fund Donation

Donate and help everyone go to Q-Camp! Through your tax-deductible donation we can assure that Q-Camp continues to be affordable to everyone in the community and remains the success that it is. We will send you a receipt for your donation. Thank You!

Your Pre-Approved Scholarship Grant (Must be a negative value i.e -125.00). 🛈

Enter the Scholarship amount that has been approved. Scholarship requests must be pre-approved prior to registering (contact Q-Camp).

Authorization

I declare I am at least 18 years old. I acknowledge activities at Q-Camp may by their nature be strenuous and/or can cause injury. I release, indemnify and hold harmless Q-Squared Men and its volunteers from any and all liability for injuries or damages in connection with Q-Camp.

I agree *

Initials *

Get Total

Click below on the 'Get Total' button. On the next screen you'll see your total and a 'Checkout with PayPal' button below. Payment will be made via PayPal. You can use a Visa, MasterCard, Discover, American Express, or an eCheck. You don't have to have a PayPal account.

Your registration for Q-Camp is not complete until your PayPal registration fee has been received.

Full refunds will be given before August 17 and discretionary refunds until August 26th.

No refunds will be given after August 26th.