VPA-EAST CABIN CAMP 2001 August 18, 2001

REGISTRATION FORM
IRS TAX ID 31-1529941
Must be mailed by August 1

Name ___________________________________________________________

Spouse ___________________________________________________________

Children ___________________________________________________________

___________________________________________________________

Address ___________________________________________________________

___________________________________________________________

Phone ________________________ E-mail ________________________ 




                                Member Non-member  # of People         Fee

Adult                           $20.00 $25.00       ________   ________________

Child (3-12 years)              $15.00 $20.00       ________   ________________

Children (below 3 years)        Free   Free

Donation (any amount)                                           ________________

Membership Fee                                                  ________________

                                                        Total   ________________
Please mail this completed registration form along with your fee (payable to VPA-EAST), by August 1, 2001 to :
Ms. Meena Gowda
1920 Chapel Hill Road.
Silver Spring, MD 20906-1117