Camp Name
Contact Information:
(please list names, titles,
e-mail addresses, and telephone numbers for up to three people)
CONTACT 1:  
Name
Title
E-mail:
Phone:
CONTACT 2:  
Name
Title
E-mail:
Phone:
CONTACT 3:  
Name
Title
E-mail:
Phone:
Shipping Addresses for Medications (no p.o. boxes permitted)  
Address
 
City
State
Zip code
Medication Shipment Reciept Dates
(please list the dates separated by semicolons, i.e. 12/24/08;12/25/08; on which to receive your shipment for each session)
This camp accepts Saturday deliveries
I can accept late deliveries(after session begins).
Medication Notes (please identify any medications(e.g. inhalers) that you will allow parents to send to camp separately)
   

NOTIFYING PARENTS

We have resources available to help introduce parents to CampRX. Please check the ones you would like us to send:
   
Brochures(please tell us how many and when you would like to recieve them)
Quantity
Sample cover letter for Parents
Web link to camprx.com
Other

PRESS SEND NOW BUTTON OR COPY THIS PAGE AND MAIL OR FAX IT TO:

CAMPRX

1001 FAIRFAX

BIRMINGHAM, MI 48009

FAX NUMBER: 1.888.341.8933