34 RANCH CAMPGROUND
RR 1, Box 37A Herod, IL 62947
Phone: 618-264-2141 Fax: 618-264-5831
REGISTRATION FORM
Click the right mouse button anywhere on the page to print.

Name: _________________________________ Name: _________________________________
Home Phone: ___________________________ Work Phone: ___________________________
Street: _________________________________ Fax: __________________________________
City:  __________________________________ Email:  ________________________________
State: _________________ Zip:_____________



CAMPSITE RESERVATION
Use Campsite Map

Section Name__________Site #_______
Section Name__________Site #_______
Section Name__________Site #_______
Arrival Date________________Departure Date____________________
Number of Nights/Per Rig___________
$25.00 (Modern) per night X #of nights = $___________
$20.00 (Primitive) per night X # of nights =$___________


LAKESIDE LODGING / CAMPER RENTAL RESERVATION

The Lookout
Number of Nights ______ x $60.00 = _____________
Number Extra Adults over 16 _____ x $10.00 = ____________
Total $ ___________

The Hideout
Number of Nights ______ x $60.00 = _____________
Number Extra Adults over 16 _____ x $10.00 = ____________
Total $ ___________

Jesse James
Number of Nights ______ x $45.00 = _____________
Number Extra Adults over 16 _____ x $10.00 = ____________
Total $ ___________

Doc Holiday
Number of Nights ______ x $45.00 = _____________
Number Extra Adults over 16 _____ x $10.00 = ____________
Total $ ___________

Billy The Kid
Number of Nights ______ x $45.00 = _____________
Number Extra Adults over 16 _____ x $10.00 = ____________
Total $ ___________




STALL RESERVATION


or $50.00 5-7 Days $_________
Covered Stall Number_____ # of Days______ X $10.00 per/day = $________
or $50.00 5-7 Days $_________
Covered Stall Number_____ # of Days______ X $10.00 per/day = $________
or $50.00 5-7 Days $________
Covered Stall Number_____ # of Days______ X $10.00 per/day = $________
or $50.00 5-7 Days $_________
Total Amount Paid For Covered Stalls $_________

PEN RESERVATION

Number of Pens _________ X $5.00 per day = $___________
Number of Pens _________ X $25.00 5-7 Days= $___________
Total Amount Paid For Pens $___________
Please add all totals.
Enter the total dollar ($) amount you will be sending for all reservations.

$__________

All stall and pen reservations must be paid in advance.

$50.00 Deposit For 5-7 Day Reservation Required
No Refunds

PLEASE SEND PAYMENT TO: 34 RANCH LLC * P.O. BOX 38 * HEROD, IL 62947