Virginia Discovery Museum
Summer Mini-Camp 2010 Registration Form
Check off your choices! Member Nonmembers
___ This Land Was Their Land $115 $140
June 14-17, Ages 4-7
___ Friendships and Fantasies $115 $140
June 21-24, Ages 4-7
___ Going Green! $115 $140
June 28-July 1, Ages 4-7
___ To Infinity and Beyond! $115 $140
July 12-15, Ages 4-7
___ Our Best Friends $115 $140
July 19-22, Ages 4-7
___ Manga Madness! $115 $140
July 26-29, Ages 4-7
___ Colorful Constructions $115 $140
August 9-12, Ages 4-7 ______________________________
Total:
Child’s Name _______________________________________ Child’s Age ______
Adult’s Name _______________________________________ Member: Yes No
Address____________________________________________________________
Phone ________________________ Email______________________________
Food Allergies or Strong Preferences _____________________________________
Method of Payment
___ Cash
___ Check
___ Visa
___ MasterCard
Credit Card #_________________________________
Exp. date ______________ VCode_______________ (3 digits on back of card)
Signature____________________________________
Cancellation Policy: 48 hours is required for refund. The VDM reserves the right to cancel programs with insufficient enrollment and will fully refund all fees in those circumstances.
Please return this form with payment to the Virginia Discovery Museum or mail to PO Box 1128, Charlottesville, VA 22902