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BERKSHIRE HILLS EMANUEL CAMPS

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					                                                                                                       SUMMER ADDRESS:
TANIA ARON
AVC Registrar
                                       BERKSHIRE HILLS EMANUEL CAMPS                                   159 Empire RD.
                                                                                                       Copake, NY 12516
Toll Free: (877) 543-4333                           Adult Vacation Center
                                                                                                       Camp Tel. (518) 329-1336
Fax: (914) 674-8952                              547 Saw Mill River Road • Suite 3D
Tania@bhecamps.com                                      Ardsley, NY 10502



                                               RATES AND DATES 2011
                                                                         Building Choices A, B, or C

                                                  (A) Canaan Negev          (B) Jerusalem Ganeden         (C) Mt. Olive, Star of
                                                     Private Bath            Tel Aviv Private bath          David, East Bank

                                                Single       Double         Single        Double          Single        Double
                                              Occupancy     Occupancy     Occupancy      Occupancy      Occupancy      Occupancy

  Trip 1              Jun 15 - Jun 29            $1320         $880           $935          $805           $665          $560

                      Jun 29 - Jul 6
  Trip 2                                         $1045         $680           $795          $620           $510          $390
                      Theme: Bridge

  Trip 3              Jul 6 - Jul 20             $1640         $1120          $1245         $995           $860          $660

                      Jul 20 - Jul 27
  Trip 4                                         $1045         $680           $795          $620           $510          $390
                      Theme: Bridge

  Trip 5              Jul 27 - Aug 10            $1640         $1120          $1245         $995           $860          $660

                      Aug 10 - Aug 17
  Trip 6                                         $1045         $680           $795          $620           $510          $390
                      Theme: Bridge
                      Aug 17 - Aug 24
  Trip 7                                         $1045         $680           $795          $620           $510          $390
                      Theme: Bridge

                      Aug 24 - Aug 31
  Trip 8                                         $1045         $680           $795          $620           $510          $390
                      Theme: Bridge

                      Aug 31 - Sep 7
  Trip 9                                         $1045         $680           $795          $620           $510          $390
                      Theme: Bridge

Fees are ALL INCLUSIVE. Full payment due no later than May 31, 2011. Round trip transportation from NYC is included. No
refunds will be made to participants who use their own transportation. Additional charge from New York airports.
CANCELATION POLICY: A $100 cancellation fee applied up to two weeks prior to trip date; 50% of fee will be forfeited for any other
cancellation (excluding medical reasons with physician documentation).
SECURITY DEPOSIT: A $50 deposit refundable after your trip will be added to your bill. Rooms will be checked before departure
for towels, hairdryers, etc.


                                                    HOW TO REGISTER:
              Return application on the next page with a deposit of $100.00 per person, per trip, to Ardsley office:
                                             BERKSHIRE HILLS EMANUEL CAMPS
                                                      Adult Vacation Center
                                      547 Saw Mill River Road • Suite 3D, Ardsley, NY 10502
                                                                                                                   Berkshire Hills Emanuel
                                           REGISTRATION APPLICATION 2011                                           547 Saw Mill River Road
                                                                                                                   Suite 3D, Ardsley, NY 10502


                                                                        DOB: _____________
Name: __________________________________________________________________________                                              Sex: M      F
                               Last Name                       First Name
                                                                         DOB: _____________
Spouse/Roomate: __________________________________________________________________________                                    Sex: M      F
                               Last Name                       First Name
Address: __________________________________________________________________________________________________
                                                                        City                       State                   Zip
Telephone: ____________________ Email: __________________________________ Roommate Preference: _______________

How do you reach BHEC? Bus_____ Car_____ Other ___________________________________________________________

Medications Taking____________________________ Medical Condition we should be aware of____________________________

  Building          (A) Canaan/ Negev              (B) Jerusalem/ Ganeden /Tel Aviv                      (C) Mt. Olive/ Star of David/
  Legend:              Private Bath                           Private bath                                        East Bank
                                              Select desired Trip below - Circle Choice

   TRIP 1         TRIP 2          TRIP 3           TRIP 4            TRIP 5           TRIP 6        TRIP 7          TRIP 8          TRIP 9
 6/15 - 6/29     6/29 - 7/6      7/6 - 7/20      7/20 - 7/27       7/27 - 8/10      8/10 - 8/17   8/17 - 8/24     8/24 - 8/31      8/31 - 9/7

                         Select desired Building below - Circle Choice (See legend above for reference)
      A              A               A               A                  A                A            A                A                 A

      B              B               B               B                  B                B            B                B                 B

      C              C               C               C                  C                C            C                C                 C

                                           Select desired Occupancy below - Circle Choice
    Single         Single          Single          Single             Single           Single       Single           Single            Single

   Double          Double          Double          Double            Double           Double        Double          Double           Double

Would you prefer a corner room? (5% additional charge)            Yes          No
Room Preference 2011___________________ Room 2010_____________________
Terms of Enrollment
I am ambulatory and able to walk without the assistance of another individual.I understand that BHEC camp grounds are uneven
and include inclining and declining steps and walkways. (Initial here) _____
I understand that medical services beyond those routine supports provided by the resident medical staff must be covered by
participants own insurance. (Initial here) _____
I agree that any dispute resulting from my stay at Berkshire Hills Emanuel Camps shall be resolved exclusively by binding arbitration
conducted by the American Arbitration Association according to their then current commercial rules. Any such arbitration will take
place in Manhattan and the substantive law of New York will apply. The arbitrator's decision will be final and may be entered as
judgement in any court having jurisdiction. (Initial here) _____

Emergency Contact (Not at camp)

                                                            Relationship: __________________________________
Name: ___________________________________________________________
                                                              Telephone: ____________________________________
Address: _________________________________________________________
                                                              Telephone: ____________________________________
Physician: ________________________________________________________
Payment             Full payment must be made by May 31, 2011

   Credit card. Please charge my credit card $ ___________________                  Circle one:   VISA       MC
Card #: ________________________________________________                       Exp. Date: ____________________ CSC #: __________
   Check. Enclosed is a check payable to Berkshire Hills Emanuel Camps In the amount of $ _________________________
Print Name: _______________________________________________________

                                                              Date: ____________________________________
Signature: _____________________________________________________

				
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