2013 Arts & Entertainment Conference

REGISTRATION FORM

Please complete all applicable information then click "Submit and Proceed to Pay" at the bottom of the page.
Registrant 1

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
E-mail
Age
Gender
Additional Registrants

Please include all additional registrants (adults and teens only) below (up to 3 additional registrants)
Registrant 2

First NameLast Name
Age
Gender
Registrant 3

First NameLast Name
Age
Gender
Registrant 4

First NameLast Name
Age
Gender
Children 12 and Under

Children 12 and under - Free.....Required for Children's Classes
Name

First NameLast Name
Age
Gender
Please list allergies or special needs
Name

First NameLast Name
Age
Gender
Please list allergies or special needs
Name

First NameLast Name
Age
Gender
Please list allergies or special needs
Payment Information
To complete your application please click Submit and Proceed to Pay. You will be redirected to a secure Paypal Page to process your payment.
Please select category and quantity.
prevnext( X )
Adult (18yrs and up)$125.00

Quantity

Family (2 adults and 2 or more teens)$275.00

Quantity

Teen (Ages 13-17)$50.00

Quantity

Non-U.S. Citizen/Resident (Outside of the United States and Canada. Puerto Rico is considered U.S.)$75.00

Total $0.00
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REGISTRATION FORM