Sample Registration form

	Your Event Name And Date at The Top. Welcome to our on-line registration process. We look forward to having you with us. The registration process is very simple. There are 3 pages. Page 1. Below are some details about this event. These details will also be e-mailed to you upon completion of this registration process. Page 2. Contact Information Page 3. Billing Information, as applicable. Event Logistics Location Date & Time Cost Sleeping Accomodations We look forward to seeing you and making this experience an enjoyable one for you. Thank you!

	Contact Information Please fill in all information below. Required Fields Signified by * (If you do not fill out the required fields, you will not be able to continue to the next page.)*
	First Name
	Last Name
	Street Address (or PO Box)
	City
	State or Province
	Zip Code
	Country
	Home Phone
	Work or Cell Phone
	E-Mail
	Emergency Contact name and phone number
	Which days and times do you plan to attend? Friday night Saturday Sunday (Please check all that apply)

	Payment Information Please start by selecting a payment option below. Based on your selection, you will be asked to fill in the appropriate information below.
	Payment Options:* Visa Master Card Amex Check
	Name on Card*
	Is the Billing Address for this card the same as already entered?* Yes No
	Billing Address for card*
	Billing City*
	Billing State or Province*
	Billing Zip Code*
	Billing Country*
	Billing Phone Number*
	Credit Card Number*
	Expiration Date*
	3-digit Security Code* The security code is the last 3 digits shown on the back of your credit card
	Amount to charge*
	Check Amount being sent*
	Date sending check* Month Day Year
	Thank you for registering with us.

Your Event Name And Date at The Top.