1. Group Affiliate Priority

For use by a Group Affiliates to nominate up to two people for priority admission to CDSS summer camp programs. This information, not necessarily on this form, and the registration and deposit from the nominee(s) are needed, by online registration, email, mail, fax, etc. in the CDSS office by March 13, 2017.

Registration online is available at http://www.cdss.org/register.html

* 1. Group Name:

* 2. Authorizing Person:

* 3. Best Contact:

* 4. Date:

* 5. Nominee 1 Name

* 6. Nominee 1 week:

* 7. Nominee 2 Name

* 8. Nominee 1 week:

Thank you for completing this questionnaire! Press DONE below and the survey will close; we will get the responses, but feel free to email Steve (camp@cdss.org) for confirmation.