Post Registration "*" indicates required fields Women's Camp Price: Name* First Last Phone*Email* Company/Organization*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How many years have you attended camp (counting this year)?:*Please enter a number from 1 to 17.T-shirt sizeSMLXLXXLEmergency Contact Name (not yourself)*Emergency Contact Cell (not yourself)*Dietary RestrictionsAllergies*Is this allergy life threatening?*N/AYesNoActivity SelectionSelect activities in order of preference (1st, 2nd and 3rd choice) for each time period.Monday, Aug. 17 – 1:30-3 p.m.1st Choice*Select OneDecline ActivityBook ChatHidden in Plain Sight: Interstellar VisitorsNature Hike – TreesSoap MakingZipline2nd Choice*Select OneDecline ActivityBook ChatHidden in Plain Sight: Interstellar VisitorsNature Hike – TreesSoap MakingZipline3rd Choice*Select OneDecline ActivityBook ChatHidden in Plain Sight: Interstellar VisitorsNature Hike – TreesSoap MakingZiplineMonday, Aug. 17 – 3:30-5 p.m.1st Choice*Select OneDecline ActivityBook ChatHidden in Plain Sight: Interstellar VisitorsNature Hike – TreesSoap Making2nd Choice*Select OneDecline ActivityBook ChatHidden in Plain Sight: Interstellar VisitorsNature Hike – TreesSoap Making3rd Choice*Select OneDecline ActivityBook ChatHidden in Plain Sight: Interstellar VisitorsNature Hike – TreesSoap Making8:15 p.m. Poker TournamentNoYes8:15 p.m. Paracord Bracelet MakingNoYesThis field is hidden when viewing the form8:15 p.m. Wine Tasting with RNDCNoYesTuesday, Aug. 18 – 8:30-10 a.m.1st Choice*Select OneDecline ActivityFly FishingNature Hike – BirdsPoliticsShotgunTomahawk2nd Choice*Select OneDecline ActivityFly FishingNature Hike – BirdsPoliticsShotgunTomahawk3rd Choice*Select OneDecline ActivityFly FishingNature Hike – BirdsPoliticsShotgunTomahawkTuesday, Aug. 18 – 10:30-Noon1st Choice*Select OneDecline ActivityAI & LeadershipFly FishingFuture of Film: Will AI Kill the Movie Industry?GolfMedia: Ask the EditorNature Hike – BirdsRifle & PistolShotgunStand Up PaddleboardTomahawkWatersports FunWhy You're Burned Out2nd Choice*Select OneDecline ActivityAI & LeadershipFly FishingFuture of Film: Will AI Kill the Movie Industry?GolfMedia: Ask the EditorNature Hike – BirdsRifle & PistolShotgunStand Up PaddleboardTomahawkWatersports FunWhy You're Burned Out3rd Choice*Select OneDecline ActivityAI & LeadershipFly FishingFuture of Film: Will AI Kill the Movie Industry?GolfMedia: Ask the EditorNature Hike – BirdsRifle & PistolShotgunStand Up PaddleboardTomahawkWatersports FunWhy You're Burned OutTuesday, Aug. 18 – 1:30-3 p.m.1st Choice*Select OneDecline ActivityBeyond WealthBourbon TastingPastries with Chef BenRifle & PistolShotgunSneaker Art BarStand Up PaddleboardTequila TastingTomahawkWatersports Fun2nd Choice*Select OneDecline ActivityBeyond WealthBourbon TastingPastries with Chef BenRifle & PistolShotgunSneaker Art BarStand Up PaddleboardTequila TastingTomahawkWatersports Fun3rd Choice*Select OneDecline ActivityBeyond WealthBourbon TastingPastries with Chef BenRifle & PistolShotgunSneaker Art BarStand Up PaddleboardTequila TastingTomahawkWatersports FunTuesday, Aug. 18 – 3:30-5 p.m.1st Choice*Select OneDecline ActivityBeyond WealthBourbon TastingMassagePastries with Chef BenRifle & PistolShotgunStand Up PaddleboardTequila TastingTomahawkWatersports Fun2nd Choice*Select OneDecline ActivityBeyond WealthBourbon TastingMassagePastries with Chef BenRifle & PistolShotgunStand Up PaddleboardTequila TastingTomahawkWatersports Fun3rd Choice*Select OneDecline ActivityBeyond WealthBourbon TastingMassagePastries with Chef BenRifle & PistolShotgunStand Up PaddleboardTequila TastingTomahawkWatersports Fun8:30 p.m. Euchre Tournament*NoYesWednesday, Aug. 19 – 8:30-10 a.m.1st Choice*Select OneDecline ActivityAnatomy of a Wrongful ConvictionArcheryArt Market Investment for Love and ValueCanoeingHeavy MachineryInternational Interventions in Failing StatesRifle & PistolShotgun2nd Choice*Select OneDecline ActivityAnatomy of a Wrongful ConvictionArcheryArt Market Investment for Love and ValueCanoeingHeavy MachineryInternational Interventions in Failing StatesRifle & PistolShotgun3rd Choice*Select OneDecline ActivityAnatomy of a Wrongful ConvictionArcheryArt Market Investment for Love and ValueCanoeingHeavy MachineryInternational Interventions in Failing StatesRifle & PistolShotgunWednesday, Aug. 19 – 10:30-Noon1st Choice*Select OneDecline ActivityAnatomy of a Wrongful ConvictionArcheryArt Market Investment for Love and ValueCanoeingHeavy MachineryIU Athletics with Scott DolsonMassagePro Football Talk with Ryan DiemRifle & PistolShotgunWeldingWorld of Watches with Moyer Fine Jewelry2nd Choice*Select OneDecline ActivityAnatomy of a Wrongful ConvictionArcheryArt Market Investment for Love and ValueCanoeingHeavy MachineryIU Athletics with Scott DolsonMassagePro Football Talk with Ryan DiemRifle & PistolShotgunWeldingWorld of Watches with Moyer Fine Jewelry3rd Choice*Select OneDecline ActivityAnatomy of a Wrongful ConvictionArcheryArt Market Investment for Love and ValueCanoeingHeavy MachineryIU Athletics with Scott DolsonMassagePro Football Talk with Ryan DiemRifle & PistolShotgunWeldingWorld of Watches with Moyer Fine JewelryInterested in staying late on Wednesday?NoEntrepreneurship for Scott DorseyHeavy MachineryDepending on availability you may attend one session after lunch with the men in their 1:30 p.m. session.Payment InformationNOTE: Payment information is only needed if an activity has an additional fee. If you total balance is $0 you can skip the payment information and submit your registration.This field is hidden when viewing the formOption* I acknowledge that Botox has an additional fee: Payment TypeCredit CardCheckCredit CardBilling Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Card Holder* Card Number* Card Expiration* Card CVV* CheckPlease include a copy of your registration, that will be emailed to you, with your check. Make check payable to Mickey’s Camp and send to: Kari Strolberg Mickey’s Camp 1336 E. Washington Street Indianapolis, IN 46202-3850This field is hidden when viewing the formTotalTotal
