Name *

First Name

Last Name

Gender *

Female

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Birth Date *

MM

DD

YYYY

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Kamper's Phone (if applicable)

(###)

###

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Parent Name *

First Name

Last Name

Parent's Phone *

(###)

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Emergency Contact *

First Name

Last Name

Emergency Person's Phone *

(###)

###

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How did you hear about KTK? *

Please Give Details in Notes Below

From a KT Kamper Family

Attended one of our Shows

Promo Card

Website

I'm a Former KT Kamper

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Other (Please Tell Us Below)