Wild at Heart BASIC
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have you attended a WAH BASIC before?
*
Yes
No
Dietary Restrictions (if none, type none)
Emergency Contact Name
*
Emergency Contact Phone
*
T-Shirt Size
*
Please Select
S
M
L
XL
XXL
XXXL
I understand that there is no refund for this event after November 10th, 2024.
*
Yes
Select "Conference and All Meals" below
*
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Conference and All Meals
$
130.00
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