Birds & Beer Registration Form
Wednesday, June 16, 2021 @ Perlick Distillery
Your Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
May we add you to our email list? We will not share your email.
*
Yes, you may add me (Select this option if you are already on our email list).
No, you may not add me.
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
May we take your picture for use in publications, press releases, and social media? We will not identify you by name.
*
Yes, you may take my picture.
No, you may not take my picture.
Would you like to register addition participants at this time?
*
Yes, there will be additional participants joining me.
No, I only want to register myself.
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Additional Participants
Use the following fields if you would like to register additional participants at the same time as you. If you are not registering additional participants, please leave the fields blank.
Participant 2 Name
First Name
Last Name
Participant 3 Name
First Name
Last Name
Participant 4 Name
First Name
Last Name
Participant 5 Name
First Name
Last Name
Participant 6 Name
First Name
Last Name
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Payment
If you would like to pay online, please select "I will be paying online" to go to the payment page. You may also choose to pay via check or cash at the program.
Payment Type
*
I will be paying online.
I will be paying via check or cash.
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Online Payment
Click the checkboxes on the left if you would like to pay for an item online. Then select the number of participants that you will be paying for.
Online Payment
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Program Registration
$
15.00
Number of Participants
1
2
3
4
5
6
7
8
9
10
Fee
Standard Program Fee
Hunt Hill Membership (optional)
$
30.00
Quantity
1
2
Type of Membership
Adult Membership
Senior/Student Membership
Family Membership
Contribute to Campership (optional)
By donating to the Campership Fund, you are helping to cover costs for those who cannot afford to pay the full price for programs. $30 covers the cost of a Youth Day Camper per day.
$
30.00
Quantity
1
2
3
4
5
6
7
8
9
10
Donation Amount
$5
$10
$20
$30
$50
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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Submit
Please click the green "Submit Registration" button below to submit your registration. You will receive an email copy of your registration form to confirm that we have received your registration.
Submit Registration
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