ED Encampment Reservation Form - GIRLS DORM


Dorms are available to current or past members of 4H or FFA.

First Name
Last Name
Email Address
COUNTY ABBREVIATION
ADDRESS
CITY
STATE
ZIP
PHONE
COUNTY AGENT or FFA ADVISOR NAME
NO BED SPACE AVAILABLE FOR YOUTHS UNDER AGE 7. ADULTS AND 7 -11 ARE ON LOWER BUNKS.
**You may reserve an additional bunk space as an area for storing your items at $15.00 each

ATTENDEE 1

Name
Member or Parent/Leader

Age only if person is 4H / FFA Member
Date










Total # of nights

ATTENDEE 2

Name
Member or Parent/Leader

Age only if person is 4H / FFA Member
Date










Total # of nights

ATTENDEE 3

Name
Member or Parent / Leader

Age only if person is 4H / FFA Member
Date










Total # of nights

ATTENDEE 4

Name
Member or Parent/Leader

Age only if person is 4H / FFA Member
Date










Total # of nights

ATTENDEE 5

Name
Member or Parent / Leader

Age only if person is 4H / FFA Member
Date










Total # of nights

ATTENDEE 6

Name
Member or Parent / Leader

Age only if person is 4H / FFA Member
Date










Total # of nights
Please note if there are any special medical needs, especially if electricity is needed for medical purposes
such as a C-pap machine, etc
TOTAL BEDS @ $15.00/NIGHT = $

If paying by check please make check out to Kansas State Fair and mail to Kansas State Fair, Education Dept, 2000 N Poplar, Hutchinson KS 67502. Please put a note on check explaining check is for Encampment Beds reserved online.



Please check if your are mailing a check
CARD HOLDER NAME
BILLING ADDRESS
TYPE OF CARD


ACCOUNT #
EXP DATE
CVI #
CARDHOLDER AUTHORIZATION SIGNATURE
Advanced reservations take until September 2. Walk-in's welcome if bed space is available.
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