Please use only one line per registrant. For more than 10 use the Excel Form .

Convention Registration 

Central States - Rocky Mountain

District Convention  APRIL 20-22, 2012

         Please fill in all boxes to insure correct registration.


Date    First Name     BHS# Chapter/Quartet Name    Chapter # Address    City State  Zip Code       Phone #      Email   

IF SPECIAL SEATING IS REQUIRED - PLEASE ADVISE.         Wheel Chair Other   Not able to climb stairs

Note: 

All competitors are required to purchase a registration. All competitors are required to file a
C&J form and Housing form that is separate from this form. Single event registrations, if available,
will be sold at the convention only.  Registrations will not be processed without full payment. 
All students less than the age of 26 are 1/2 the regular price.  Early discount for students is 1/2 the regular discount. 

Early discount ends April 1, 2012

ENDED
Please fill in an individual box for each registrant (including yourself), both for members and non members. First and Last names!
If it is necessary to add more registrants send in more than one form electronically.		 Fill in the membership
number for each registrant in the box below. 
If family or spouse, indicate in Membership Column
 Early
Registration

 Early
Student
Registration		   Enter the  amount due
in the box below after 
each name,
then enter a grand total.
Fill one Registrant  name per box below. Membership # $50.00 $25.00   Total
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
    Grand Total

ALL SEATS RESERVED FOR ALL CONTEST SESSIONS
Payments using this form will be through Paypal.
Credit Cards are accepted through Paypal as well as being able to make a payment using your Paypal account.
No Paypal account is needed to use this service.
After you submit this form you will be taken to the payment page where you can pay through paypal using a
paypal account or credit cards.
A confirmation will be sent to you from Lonnie.
Mail completed forms to:
CSD Registration Chairman
Lonnie Miner
519 S Chicago Ave
Hastings, NE 68901-5830		 Registrations and tickets are NON refundable.

Additional fees will apply to declined credit cards.

Registration packages will be available in the conventions registration area.
Registration questions?
Phone: 402-462-2630 or 402-469-3945
Email: bbscsd@windstream.net