Camp Bernie YMCA

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Group/Organization Name*

Mailing Address

Primary Contact Name*

Billing Contact Name

Primary Email*

Billing Email

Primary Telephone *

Billing Telephone

Requested Trip Dates or Time Frame

Arrival Time

Departure Time

Meals You’d Like Us to Include (If Any)

Expected No. of Participants

Expected No. of Chaperones (if applicable)

Is your group going to be taking part in Camp Bernie activities, doing your own programming, or a mix of both?

How did you hear about us?

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