A September to Remember 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:  

Space Requested

Please choose the amount of space you would like at the crop:

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?