Regionals Registration Form

Spring Regionals: San Antonio, TX Agent Registration Form

Please complete all fields below! If you have questions, or for more information, contact Kristina G. Bertels at southtexasregionals@gmail.com. We look forward to seeing you at Regionals in San Antonio, TX on March 16, 2024!
Name*

First NameLast Name
Agent ID*
Sponsor Name*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
What is your current rank?*
Who is your Founder’s Council member?*
Are You Bringing A Guest/ Guests?*
Guest/ Guests Name (Required For Gifts That Will Be Awarded):*
Form of Payment*

CashApp (send to $kgbertels)Zelle (send to 210.362.4842)
If sending payment via CashApp, please provide your CashApp tag/name? (This will allow us to match your registration form to your payment)*
Please read carefully and fill in name below: I, the agent, understand that I must pay $35 prior to the Regionals event via CashApp to $kgbertels, or via Zelle: 210.362.4842. I understand that my ticket/seat is not confirmed until payment has been made. I understand that if I do not pay prior to the Regionals event, and I go to the event, I will be required to pay $45 at the door via CashApp or Cash. All guests are free.*
Room Block Information

If you are wanting or needing a room, we do have a room block at the hotel (Riverwalk Plaza). You can copy the link below and paste it into your URL, to reserve your room. Deadline to book your room is March 1, 2024. http://bookings.ihotelier.com/bookings.jsp?groupID=4220680&hotelID=131337
Should be Empty:

Spring Regionals: San Antonio, TX Agent Registration Form

Room Block Information