Virginia Space Flight Academy - Printable Registration Form

Tuition for all 2010 residential camps is $695. Included in this fee are all camp activities, housing, cafeteria meals, transportation to all camp activities, a work book, camp T-shirt, and all materials.

Check one:	June 27-July 2	July 18-23	August 8-13
	July 11-16	July 25-30	August 15-20
		August 1-6

Camper's Name:	_______________________________
Age:	________ Gender: Male / Female
Email:	_______________________________
Address:	_______________________________
City:	_______________________________
State:	__________	Zip: __________
Is the Camper a U.S. Citizen?		Yes / No

Has the camper attended Space Flight Adventure Camp at Wallops before?	Yes / No
Number of 1-week camps attended before:____

Parent/Guardian Name:

________________________________________

Day Phone:	_________________________
Evening Phone:	_________________________
School:	_________________________

Camper's T-Shirt Size: (Check One)
Adult	S	M	L	XL

Check Enclosed
Please make check payable to: VSFA
(Virginia Space Flight Academy)

Mastercard

Visa

For credit card payment, please complete:
I authorize charges of $695.00 to the card listed below for deposit in the VSFA account.

** Please note that space will be reserved for students, but credit cards will not be charged until after Jan 1, 2010

Card #:	_________________________
Exp. Date:	_______/_________

Print name as it appears on credit card:

_________________________

Signature: _________________________

After completing this form, please mail it along with your check (if applicable) to:

Space Flight Adventure Camp
Registration
7290 Enterprise Street
Wallops Island, VA 23337

Space Flight Adventure Camp is committed to providing equal educational opportunities without regard to race, sex, color, national origin, religion, or handicap.

Privacy Notice: The sign-up and credit-card information is used only for Virginia Space Flight Academy registration purposes. This information is not provided to organizations, companies, or persons not directly involved with the management of Space Flight Adventure Camp.

Cancellation / Refund Policy: VSFA incurs certain costs prior to camp such as room and meal guarantees; therefore, in the event of a cancellation 2 weeks prior to camp date, a refund of $495.00 will be applicable. In the event of a cancellation less than 2 weeks prior to camp date, there will be no refund unless there is a medical statement signed by camper's physician in which case the $495.00 refund will apply.