CHILD
REGISTRATION

Parent/Guardian Personal Info
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Phone*
Important: Make sure the "on site" number, above, is one we can just to reach you during the conference.
Child Information
Registration Quantity*
Price: $75.00
Child Info*
Full Name Age Gender
Describe any special needs, dietary, or other requirements.
Authorized Pickup: Names of those authorized to pick up your children
Name Phone Number
Emergency Contact Name
First Last
Emergency Contact Phone
Checkout
Transaction Fee
Price: $0.30
This is a flat fee in addition to a percentage for each credit card transaction.
Total
$0.00

Credit Card

Cardholder Name

Card Details

PLEASE REVIEW ALL OF THE INFORMATION YOU'VE ENTERED BEFORE HITTING "SUBMIT", BELOW.

Parent/Guardian Personal Info

Full Name	Age	Gender