2013 Camp e3 Registration

The EIU Camp e3 is sponsored by Midland States Bank and is a 3 night - 4 day camp that will be held on the Eastern Illinois University campus in Charleston, IL. The EIU camp is June 23 - 26, 2013 starting at 5:30 p.m. on Sunday, June 23 and ending Wednesday, June 26, 2013 at 1:30 p.m. Registration w/ lodging is $395. Non-lodging option is $370. A limited number of scholarships are available.

Camper Name
* First Last
* Male Female
What is your age? *
Do you have any special needs?
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Mother's Name First Last
Father's Name First Last
Camper's Email
Parent's Email *
Best phone to reach camper - (###) - ### ####
Best phone to reach parent * - (###) - ### ####
T-shirt size X-small Small Medium Large X-large XX-large
What school do you attend and what grade are you in?
Payment information $395 - Includes 3 nights lodging, 3 dinners, 3 lunches, 3 breakfasts, t-shirt and materials $370 - Non-lodging option
There are a limited number of partial/full scholarships available. To be eligible for this the camper must be able to demonstrate financial need. Please describe financial need in box below.
The camper requesting a scholarship must also write a brief essay telling us why they want to attend Camp e3. Please write Scholarship essay here.
Paying by: Check Credit card Applying for full scholarship Applying for partial scholarship
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How did you hear about us? website teacher referral other
Please let us know the website, teacher, referral or other information here.