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                    1999 Pete Gillen's Basletball Camp - Application

INDICATE PREFERRED WEEK OF CAMP: __ July 11-15,1999 for ages 8-15 located at Graves' Mountain Lodge $375.00

                                                                __July 25-29, 1999 for ages 10-17 located at the University of Virginia $365.00

NAME___________________________________________________________________

MAILING ADDRESS_____________________________________________________________________

CITY______________________________________State______________________Zip Code____________

PARIENT/GUARDIAN__________________________________________________________________

AGE______________DATE OF BIRTH_______GRADE ENTERING FALL OF'99_______SCHOOL___________________________

HOME PHONE________________________________ROOMMATE REQUEST (Limit One Name)____________________________

BUS.PHONE_________________________________

MAKE CHECK PAYABLE TO PETE GILLEN'S BASKETBALL CAMP

Full camp tuition is due with your application.

 

MAIL TO: Pete Gillen's Basketball Camp, Inc.
P.O. Box 3785,
Charlottesville, VA 22903

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