Registration  Form     

The 2010 Montana Men's Gathering

Camp Mimanagish, September 23– 26, 2010

Name: __________________________________ Address: ______________________________________________

City: ___________________________________________________ State: ____________ Zip :____________________________

Phone: ______________________________ Email: _____________________________________________________

Age: ____ How did you hear about this event?: _______________________________________________________

  Please check what applies to you:

  ___ $365 full registration, includes meals and lodging.

  ___ $100 deposit (remainder of $265 will be due when you arrive at Camp Mimanagish )

  ___ I cannot attend this year's event or I am coming but would like to contribute more than the base fee. I'd like to support the Montana Men's Foundation with a tax deductible donation of: ___$50 ___ $100 ___ $365 ___ Other.

Partial scholarships may be available for younger men and those with financial hardship. To inquire, please contact Bill Bucher at 406-442-7591 or bbucher@mt.net.

Please enclose full amount or a $100 deposit. Make checks payable to: The Montana Men's Foundation

Mail to: Drum Brothers - PO Box 268 Arlee, MT 59821

Visa/MC#___________________________________________________________________ Exp.Date_________________

CVC/CVV code ________________ (3 digit code on back of card)

Signature_________________________________________________ Amount due___________  Amount enclosed___________

Upon receiving your registration, we'll send you a letter confirming details, directions, and schedule. For questions, contact Bill Bucher at 406-442-7591 or bbucher@mt.net. Note: In the event of cancellation a $30.00 administration fee will be retained. There will be no refund if you cancel after September 18, 2010.