I would like to attend Camp Mabon 2012 . . .
Please type or print all information clearly. Mail your completed application to Deb Downing, c/o VSDVAA,
5008 Monument Ave., Ste. A, Richmond, VA 23230; or fax the form to 804-377-0339. The deadline for
applications is July 31. (Questions? Email Deb Downing, debdowning47@gmail.com.)
Name: _______________________________________________Daytime phone: ___________________
Email address: ________________________________________ Evening phone: ____________________
Mailing address: ________________________________________________________________________
I would like to attend Camp Mabon 2012 because . . . (attach an extra page, if needed)
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I learned about Camp Mabon from . . .
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What would you like to get out of the Camp Mabon experience?
______________________________________________________________________________________
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Please list any food allergies or other special needs (including physical challenges):
_______________________________________________________________________________________
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Please respond to each of the following statements:
o I can provide my own transportation to Douthat State Park. yes no
o I can provide my own transportation to a pickup site. yes no
o I can transport others to a pickup site. yes no
o I need transportation to a pickup site. yes no
o I have attended Camp Mabon before. yes no
__ 2005 __ 2006 __2007 __2008 __ 2009 __ 2010 __ 2011
o I have a financial sponsor. yes no
If yes, please provide
o sponsor name __________________________________________
o sponsor phone number ___________________________________
o sponsor email __________________________________________