Agreement for Use Name * First Name Last Name Date(s) of Event * Church Name or Group Name * Church Address (if applicable) Address 1 Address 2 City State/Province Zip/Postal Code Country Group Type * (e.g. Men, Ladies, Teens, etc.) Group Leader / Contact Person * Leader Email * Leader Phone * (###) ### #### Total number in your group (including sponsors) * Date & Time of Arrival * Date & Time of Departure * Do You Need Meals to be Provided? * Yes No Total # of Meals Day and Time of Each Meal Needed Please Contact Me About Program Activity Options * Yes No How did you hear about Mt. Lou San? Digital Signature * *As the group leader, I have read the “Conditions for Use”, and our group agrees to abide by those regulations during our stay at Mt. Lou San Bible Camp. Furthermore, we hereby release and discharge Harrisburg Bible Forum financial responsibility resulting from or arising out of any incident, injury or accident occurring while our group is attending Mt. Lou San Bible Camp. I agree that the digital signature below acts as my real signature. **Remember, any changes to this information must be made at least one week in advance, and payment is due upon arrival. Thank you! Download Conditions for Use
