Name of Attendee:

Street address:

City:   State:   Zip:   Phone, incl area code:

Your E-mail address: (Important! Please check accuracy.)

Please indicate the number of people registering: eg, one for $30, two for $60, etc.

• 1 person - $30
• 2 people - $60
• 3 people - $90
• 4 people - $120

If this is a registration for more than one person, please list names others below.
Name of Other Attendee (1):

Name of Other Attendee (2):

Name of Other Attendee (3):

Please make any comments here.

When you've entered and reviewed all items, click on the    Payment Page    button, below.
   Thanks for registering for the BCP Banquet!

On the >> << you select the total fee and submit it to PayPal for payment.