The 34th Annual BAPA Convention
Event Registration
Name
*
First Name
Last Name
Email
*
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Categories:
All
All
Number of Rooms
Meals
Membership (Non-Lifetime members)
Donors
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next
( X )
Registration With a Room
Enter description
Free
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Registration Without a Room
$250.00
$
250.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Number of Rooms
Friday (optional)
$220.00
$
220.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Saturday
$220.00
$
220.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Meals
Member
$230.00
$
230.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Spouse/Guest
$230.00
$
230.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Child 4-11yo (Sat&Sun)
$100.00
$
100.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Child Below 4 yo
Free
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Membership (Non-Lifetime members)
Annual
$50.00
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Biennial
$100.00
$
100.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Life
With 50% Discount
$500.00
$
500.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Donors
Diamond
$2,000.00
$
2,000.00
Platinum
$1,000.00
$
1,000.00
Gold
$500.00
$
500.00
Silver
$300.00
$
300.00
Bronze
$200.00
$
200.00
Pay by Mail:
Please make all checks payable to the Bangladeshi-American Pharmacists' Association | Mail to: BAPA, 125 Ash Drive, Roslyn NY 11576
Pay by Zelle:
Pay to: bapapresident@bapainfo.org
Please verify that you are human
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