Saskatchewan Provincial Good Sam Samboree     

   Weyburn, Saskatchewan.

 June 6 - 10, 2012

Notations:       1. If groups wish to park together, they must arrive together. No exceptions.

                        2. Gates will not be open until 8:00am Wednesday.

                        3. Register before January 31, 2012 for a chance to win a free registration.

                        4. Registration must be paid in full at time of application.

                        5. Refunds after May 15, 2012 will be provided for medical reason.

                6.BE SURE YOUR FRESH WATER TANK IS FULL

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2012 Registration

Pilot _____________________________  Co-Pilot _________________________________

           (Last Name)       (First Name)             (Last Name)               (First Name)

Address ______________________________  City ___________________________ Prov./State _____

Postal/Zip ______________ Telephone ___________________________ E-mail ____________________

Good Sam Chapter ______________________________ Good Sam Membership #____________________

First Time Samboree?   Yes ___ No ___ How Many Samborees have you attended? ___________________

Extra Guests Names ________________________________________________________

Special Needs: ___________________    Electrical required   Yes ____   No_____

                                                            Mobility only     ___

 Registration must be paid in full at time of application

Registration Fees- Power Extra                                                      

RV with 2 adults    $109.00                __                                           

RV with 1 adult      $ 84.00                 ____________                       

Additional adult     $ 25.00                 ____________                       

Electric only          $ 40.00                  ____________                      

(Banquet & Pancake Breakfast included in above rates)

 Total Cost                                 

 Mailing Instructions:

Registrar

Kathy Henfrey, 1427 Benjamin Crescent, Regina, SK.,Canada S4X 4L3

Phone 306 543-9801     

Make Cheques Payable To:

Saskatchewan Samboree