Online Registration Form
Kennedy Space Center Campout
Fathers Information
First Name:
Last Name:
Phone Number:
Email Address:
Date of Birth:
Last 4 digits of Social Security Number:
Tribe/Circle:
Select Tribe
Blackfoot
Iroquois
Mohawk
Pocomoke
Shoshone
Yellow Knives
Total Number of Campers
Select Number of Campers
Two campers = $200
Three campers = $300
Four campers = $400
Address:
City:
State:
Zip
Drivers License State
Fathers Dinner Order
Select Dinner Choice
Grilled Chicken Sandwich
Hamburger
Cheeseburger
Veggieburger
Hot Dog
Son's Information
Son 1 Name
Son 1 Dinner Order
Select Dinner Choice
Grilled Chicken Sandwich
Hamburger
Cheeseburger
Veggieburger
Hot Dog
Son 2 Name
Son 2 Dinner Order
Select Dinner Choice
Grilled Chicken Sandwich
Hamburger
Cheeseburger
Veggieburger
Hot Dog
Son 3 Name
Son 3 Dinner Order
Select Dinner Choice
Grilled Chicken Sandwich
Hamburger
Cheeseburger
Veggieburger
Hot Dog
If you are satisfied with the above information you entered and are ready to proceed to the next registration step (payment options), click the button below:
If you would like to start over and re-enter ALL information (WARNING - ALL FIELDS ARE CLEARED!), click the button below: