EmailMe Form - 2012 LMBBSA Conference Registration Form

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Email

Phone

### - ### - ####

Registration fee

Extra guest for dinner Friday night $15.00 each

If bringing extra guests please indicate how many.
Unregistered children must purchase a meal if you plan to bring them to the Friday evening dinner

Extra guest for Saturday Luncheon $15.00 each

If bringing extra guests please indicate how many.
Unregistered children must purchase a meal if you plan to bring them to the Saturday luncheon

We have conference T-Shirts available for $10.00 each. If interested, please indicate how many in each size:

Youth sizes:
Small, medium, large

Adult Sizes:
Small, medium, large
XL, XXL, XXXL

Form of payment:
Please indicate if paying by check, money order or Paypal

Check

Money Order

Paypal

For Paypal payment: Visit www.paypal.com
Pay to LMBBSA@yahoo.com
Please add a $3.00 processing fee

or

Send check or money order to:
Claudia Parker
Secretary/Treasurer, LMBBSA
9688 Oaktree Terrace
Midwest City, OK 73130-3538