Online Event Registration and Payment

Demographic Information

Last Name:	*
First Name:	*
Middle Name:
Name on Badge:	enter name how you want it to appear on name badge
E-Mail:	*
	Please ensure that your e-mail address is correct. A confirmation of your transaction will be sent to this e-mail address.
Address:	*
Address 2:
City:	*
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *
ZIP Code:	*
Phone:	xxx-xxx-xxxx
Age:	*
Chapter:	Please Choose... Albany Chapter Cecil Cheves Chapter Clayton Chapter Columbus Chapter Currahee Pilot Chapter David A. Porterfield Pilot Chapter Don R. Roberts Chapter Grady T. Bozeman Pilot Chapter Greater Augusta Pilot Chapter Laurens County Pilot Chapter Middle Georgia Chapter Mountain Park Chapter Peachtree City Chapter Rufus R. White Pilot Chapter Samuel S. Lawrence Chapter Walton County Pilot Chapter Ware County Club Georgia At Large Out of State *
Category:	Please Choose... Active DeMolay Senior DeMolay DeMolay Advisor Parents Club Sweetheart Rainbow Member Rainbow Advisor Other Minor Female Guest Other Minor Male Guest Adult Guest *

Registration Information

What registration package would you like?
Choose Package:	Package A (Competitor) - $35.00 Package B (Dinner/Dance Only) - $15.00
Do you have a voucher for a registration discount?
Discount Code:

Terms and Conditions

Late Fee
A late fee of $25 will be automatically added to the price of registration after January 27, 2012.

Refund Requests
No refunds will be granted after January 27, 2012.

Advisor Approval Required
An advisor from the registrant's Chapter must attend the event to supervise this registrant, if the registrant is an active DeMolay or another young man for which supervision would be appropriate. For a Sweetheart or minor female guest, an advisor must select a qualified, approved chaperone to attend to supervise the Sweetheart or minor female guest. An advisor of each Chapter will be contacted approximately two weeks prior to the event to approve all registrants for that Chapter. If the advisor does not approve a registrant to attend the event for a valid reason, a full refund will be issued and the registrant will not be allowed to attend the event.

Medical Release Form Required
Registrant must download the medical release form for this event, print the document, fill it out, and bring to the event. Failure to bring this medical release form filled out and signed by a parent or guardian with a copy of the registrant's insurance card may result in forfeiture of fees and the denial of entry to the event. You may download the Medical Release Form here: http://gademolay.org/resources/forms/medicalrelease.pdf.

Prohibited Items
DeMolay Functions are drug, alcohol, and weapon free. Georgia DeMolay reserves the right to search any bag or room for cause. Registrants who are in possession of prohibited items will be removed from the event without refund.

I have read and agree to the terms and conditions for this event.

(be sure to read and agree to the terms and conditions before clicking "Continue")