Durbar 2017 Registration Form

Name: _________________________________________

Camp Nickname: _________________________(REQUIRED or I'll make one up!!!)

Spouse/Guest: ___________________________________

Guest #3: _________________________________________

Guest #4: _________________________________________

Address: _______________________________________

City/State/Zip: ___________________________________

Phone: ____________________Email: _________________________________

Arrival Date: __________________ Checkout Date: ______________________

King or Two Doubles (request only)(Circle)

For Otesaga lodging only: 

Credit Card Number: __________________________________ Exp Date: _______

Name on Card:__________________________________ Security Code:____ (or call me)

We are making our own lodging arrangements and will not be staying in the Otesaga:  

I/we will eat dinner at the Otesaga on June 22(#):____; June 23 (#) ____; June 24 (#)_____

Durbar fee (to help defer the cost of the hospitality suite and memento): Otesaga Residents: $15.00 per person; Not staying at the Otesaga: $30.00 per person

I am enclosing a check made out to "Shellback Cruises" for:_____________________

Mail to:

Shellback Cruises, 2131 Westrivers Road, Charleston, SC 29412