Maintenance Connection Registration

Maintenance Connection Registration
Name of your Organization/Group*
Business Phone Number for Your Organization/Group*
Please enter a valid phone number.
Address for you Organization/Group*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How many total individuals are your registering?*
If you plan to register more than 4 people, please contact the camp office before proceeding.

Registration for Person #1 -- Main Contact Person
Person #1 -- Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Room Choice
Roommate's First and Last Name (if applicable)
Please describe any food or room accommodations that this person needs.
(for example: do they have a gluten allergy or need a handicap accessible room?)
Does this person need a shuttle to and/or from Pittsburgh International Airport? (fee of $30 per person)

YesNo

Registration for Person #2
Person #2 -- Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Room Choice
Roommate's First and Last Name (if applicable)
Please describe any food or room accommodations that this person needs.
(for example: do they have a gluten allergy or need a handicap accessible room?)
Does this person need a shuttle to and/or from Pittsburgh International Airport? (fee of $30 per person)

YesNo

Registration for Person #3
Person #3 -- Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Room Choice
Roommate's First and Last Name (if applicable)
Please describe any food or room accommodations that this person needs.
(for example: do they have a gluten allergy or need a handicap accessible room?)
Does this person need a shuttle to and/or from Pittsburgh International Airport? (fee of $30 per person)

YesNo

Registration for Person #4
Person #4 -- Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Room Choice
Roommate's First and Last Name (if applicable)
Please describe any food or room accommodations that this person needs.
(for example: do they have a gluten allergy or need a handicap accessible room?)
Does this person need a shuttle to and/or from Pittsburgh International Airport? (fee of $30 per person)

YesNo