2015 CMA INDIANA STATE RALLY
At Shiloh Retreat Center
1734 S. 350 E.
Marion, IN 46953
**SHILOH PARK IS A TOBACCO, DRUG & PET FREE FACILITY**
(September 17-20, 2015)
REGISTRATION FORM
NAME: _______________________________ CMA#_____________
Adult
NAME: _______________________________ CMA#_____________
Adult
NAME: _______________________________ CMA#_____________
Youth/child Age___
NAME: _______________________________ CMA#_____________
Youth/child Age___
GUEST: _______________________________ CMA#_____________
Age____
GUEST: _______________________________ CMA#_____________
Age____
Address: _________________________________ City: _______________ State: ____ Zip: _______
Phone #:_________________ Chapter #_______ Chapter Name: _________________________
Adult (18+)
Child (4-11)
Youth (12-17)
Family (max 2 adults)
Pre-Registration
$ 10.00
$ 5.00
$ 5.00
$ 30.00
On-Site
$ 15.00
$ 7.50
$ 7.50
$ 35.00
On-Site Registration Hours at State Rally
Thurs: 3:00 pm to 6:45 pm
Fri: 9:00 am to 12:00 & 2:00 pm – 6:30 pm
Sat: 8:00 to 9:00 am & 11:00 am to 12:00 pm
Adults (__) x ____ = $_______ , Youth 12-17 (__) x ____ = $_______ Child 4-11 (__) x___=$_____
Family (max 2 adults) $_______, Non CMA Members & Guests pay no Registration Fee
Total This Section $________
MEAL PLANS Must Pre-Register for Meal Plans By August 31, 2015
Adults (9 and Up) $9.00 per meal
PLAN A:
PLAN B:
PLAN C:
PLAN D:
PLAN E:
Ages (4-8) $4.50 meal, 3 & under free
Fri. 6pm, Sat. 7am, Sat. 5pm, Sun. 7am Adult $36.00
Fri. 6pm, Sat. 7am, Sat. 5pm
Adult $27.00
Sat. 7am, Sat. 5pm, Sun. 7am
Adult $27.00
Sat. 7am & 5pm
Adult $18.00
Sat. 5pm, Sun. 7am
Adult $18.00
Child/Youth$18.00
Child/Youth$13.50
Child/Youth$13.50
Child/Youth$ 9.00
Child/Youth$ 9.00
Adult Meal Plan (___) _____x____= $______ Child/Youth Meal Plan (___) _____x____= $______
Total This Section $________
State Rally Lodging & Camping
Tent Camping (Electric & Water) per night $18 x ___=________
RV Camping (Electric, Water & Sewer) per night $35 x ___=________
ALL LODGING: Call First Before Reserving (*2 night stay Minimum. each below **)
Taylor, Stone & Spruce Dorms (4 units per Dorm w/8 bunks beds-A/C-Showers, Toilets)
Each Dorm Room is $50.00 per room (Minimum 8 people per room if chapter is reserving a room)
Handicap Rooms: Taylor 2, Stone 4, Spruce 1
Updike Dorm
(4 units per Dorm w/8 Bunk beds-A/C-Men’s and Women's Facility in center of bldg.)
Each Dorm Room is $35.00 per room (Minimum 8 people per room if chapter is reserving a room)
Winchester Cottage: 5 Bedrooms
$35.00 (per night/per room) x ____=_____________
Share his/her bathrooms, Kitchen & Living room
1) 2 twin beds, 2) 2double beds, 3) 1 double bed, 4) 1 double Bed, 5) 1 double bed
**ALL ABOVE REQUIRE LINENS-TOWELS-PILLOWS & CASES, ETC.**
Total this Section $_________
***PRE-REGISTRATION & MEAL PLAN MUST BE IN BY August 31, 2015***
NEW THIS YEAR!
CMA INDIANA Micro Fiber Towels
$5.00 X ____ = ______
Total This Section $________
Pre-Registration
$_____________
Meal Plan Section
$_____________
Lodging -or- Camping
$_____________
Micro Fiber towel
$_____________
TOTAL of ALL 4 Sections $______________
Paid by Check #
________
Paid by Cash ________
Received by__________
Make Checks payable to: ”CMA TREASURER OF INDIANA”
Mail to: Brenda Hottel, 1500 W. Old Dam Rd., New Harmony, IN 47631
(Cell: 812-781-0146)
NO Refunds
**SHILOH PARK IS A TOBACCO, DRUG & PET FREE FACILITY**