Registration Form for Summer Camp 2005

Centro de Interpretación Ambiental Kuyimá

1. Fill out the form,
2. Print it out, then
3. Send it to us by fax (from the US: 011-52) 615-154-00-70, or print it in PDF format and send it to: kuyima@prodigy.net.mx , 
   as soon as possible.

July 2 to 10    – Departure from Tijuana and Ensenada
July 9 to 17    – Departure from Tijuana and Ensenada

July 16 to 24  – Departure from Cabo San Lucas and La Paz

Participant Information
      Participant's Name:
      Date of Birth: (dd)(mm)(yy). Grade:
      Place of Birh: (city, state)(country)

      Father's Name:
      Mother's Name:

Home Address
      Street Address:
      City:  
      State:
      Zip Code:   Country:

Telephone at home: at work:
      Cell Phone:
      E-mail Address:

Contact Information (in case someone else is in charge during the program)
      Name:
      Street Address:
      City:  
      State:
      Zip Code:   Country:
      Telephone:
      Email Address:
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