Black Range Camp
Reservation Form

Print this and mail to:
Black Range Camp
P. O. Box 152
Winston, NM  87943

Name     ____________________________________________________

Boy     _____    Girl    _____     Age    _____

Address ___________________________________________________

City    _____________________     State_________   ZIP_________

Phone   ____________________________________________________

_____ July 6 through July 19, 2008   Full Session - $800.00

_____  July 6 - July 12, 2008 Half Session - $450.00 - If Available

_____  July 13 - July 19, 2008 Half Session - $450.00 - If Available