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Baptist Camp & Conference Center

Please note: You will still have to fill out a paper registration for with signatures and medical information.

    
Today's Date
Camp Name L#
Camp Date
Campers First Name
Campers Last Name
Address
Address 2
City
State
Zip
Male or Female
Birth Date
Age in June
Grade Completed in June
Email Address
Phone Number
Additional Emergency Phone
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
Zip
CVV2/CID
Amount to charge
Comments