Yes! I am interested in attending the West Goshen Township of Liberty and Ellis Island on June 25, 2011!

Name:_______________________Telephone:__________________

Address:_______________________________________________

______________________________________________________

Number of participants:_____ Total payment ($40/person):___________
(Make checks payable to "West Goshen Township.")

Please inform me of future West Goshen trips via email at __________________

Sorry, we are unable to process electronic payments.

Please return completed Registration Form, along with a Participant Recreation Form for each participant over 18 years of age and a Parental Permission Form for each child under age 18 with payment to:

West Goshen Township
Park and Recreation Department
1025 Paoli Pike
West Chester, PA 19380