Membership Form

(We guarantee your name will not be sold by camp as part of a list.)

First/Chosen Name:

Last Name:

Maiden/Former Name:

Gender

MaleFemale

Camp Nickname:

Date of Birth: (form: 3/19/69)

Spouse's Name:

Children's names and years they have
attended Camp (if any):

Address:

City:

State/Province:

Zip Code:

Country:

Area Code & Phone Number:

E-mail (only one please):

Include Email In our Directory?

Yes No

Personal Web Page:

Your association with Camp (ex. camper 65-67, staff 68-69, other)

Association:	Years:
Camper during years:
Staff during years:

Are you interested in helping with functions of the Torchbearers?Yes No

Please check the events you would be interested in attending.

General Reunions of staff and campers

Gatherings which include families

Torchbearer trips

Please check the ways you would be interested in helping Camp Tecumseh.

Nature Center Guide

Contacting Old Friends

Reforestation and Trail Restoration

Providing financial support

Other

Please provide names and addresses of any other camp people with whom you are in contact so we can send Torchbearer information.

Name:	E-mail	Address:

Please mark items that you would like to receive information about.

Summer Camp

Family Camp

Torchbearer Events

Retreat Facilities

Leadership Programs

YMCA Camp Tecumseh Endowment Fund (Trailblazer Society)

Please share how Camp Tecumseh experiences have influenced your life since camp.

We would like to include information about where you are and what you are doing now in our Torchbearer Newsletter. Please give us any details you would like mentioned.

The individual requesting this information is OVER the age of 13.

Camp Tecumseh YMCA does not give or sell contact information to any other organization or entity.

Any information collected from a minor 13 years of age or younger will be used only to respond directly on a one-time basis to a specific request from the child and is not used to re-contact the child and is not maintained in retrievable form by Camp Tecumseh YMCA. For more information on the Children’s Online Privacy Protection Act, you can go to www.ftc.gov/kidzprivacy.