Rockin' With the Diva Registration Form

There are two ways to register:

  • Print out the registration form and mail it in with your payment; or
  • Register online using the form below with the option of sending your check in the mail or paying online *securely* through PayPal. Payment instructions are on the next page.

 

Fields marked (*) are required

Personal / Contact Information

*First:      *Last:  

*Address:  

*City:    *State:    *Zip:  

*Phone:     Alt Phone:

Email:  

Seating Requests

Please list the names of all persons you wish to sit with and select where you would like them to sit. We will do our best to accommodate your wishes.

Seatmate 1:

Seatmate 2:

Seatmate 3:

Seatmate 4:

Seatmate 5:

Special Requirements

Do you plan to bring extension cords for your electrical needs? If so, what items will you be using at your table?

Do you follow a special diet or have physical limitations that we need to provide services for?

Attendance Options

Please choose when you will be attending:

Partial Weekend Spots

Partial weekend spots will open after November 30, 2011 and will be based on availability. To register for a partial weekend spot, please print out the registration form and MAIL it to the Diva with your payment.