CAMP PELLISSIPPI CAMP USAGE FROM
Reservaon form is due to Council oce two week prior to your arrival date.
$25 Reservaon Fee
Council/Other Organizaon ___________________________________________________________________________
Unit Type: ______________ Unit Number:____________ Number of Youth:____________ Number of Adults ________
Arrival Date & Time:_________________________ Departure Date & Time:___________________
Leaders in Charge—Two Deep Leadership Required
Name One ________________________________ Name Two __________________________________
Phone One ________________________________ Phone Two __________________________________
Email One ________________________________ Email Two __________________________________
Facilies
Check all that apply
OUT OF COUNCIL/
CAPACITY GSMC FEE OTHER ORGANIZATIONS
40 $30 $50
30 $30 $50
30 $25 $35
40 $25 $35
12 $25 $35
30 Free $20
30 Free $20
30 Free $20
30 Free $20
30 Free $20
50 $30 $50
25 $25 $35
8 $50 N/A (must provide ocers)
FACILITY
____ Winter Lodge
____ Cabin 14
____ Carter Cabin
____ Arthur Wood Lodge
____ Cabin 5
____ Hill Top Campsite
____ Trails End Campsite
____ Terrace View Campsite
____ Sta Area Campsite
____ Walnut Grove Campsite
____Parade/Pavilion
____ Pavilion 2
____ Shooting Range
____ Canoes (on site only) $10 each $10 each # of Canoes _________
Facility Fees $_______ x Per Night_______ =$_______
GSMC Parcipant Fee $2 per person ________ =$_______
OOC/Other Fee $5 per person _______ =$_______
Canoes #_______ =$_______
Reservaon Fee $25 $__-25___
Total Amount Fees Due =$________
Make Checks payable to GSMC. Mail to PO BOX 51885 Knoxville TN 37950.
Credit Card Payment:
#_____________________________________________________ EXP__________ CVV___________
__________________________________________________________________________________ Date___________________
Signature
In the event of last minute cancelaon, please call Ranger at 865-256-4245.
Please contact Jennifer Williams for Shoong Ranges at 865-588-6514.
click to sign
signature
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