2023 Convention Registration Form

Pez on the River 11th Annual Pez Convention!

Please fill out one registration form per person
Full Name*

First NameLast Name
Preferred Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number*
Format: (000) 000-0000.
YesNoMaybe
Payments can be made through PayPal to:

Pezontheriver@gmail.com

or a check can be sent to:

Pez on the River

W28292 State Road 54-35

Trempealeau, WI 54661
How will you be making payment? (NOTE: Checking this does not make payment)
Please verify that you are Pezhead :)*
Should be Empty:

Pez on the River 11th Annual Pez Convention!