North Central Regional / Park Falls Registration Form

North Central Regional / Park Falls Registration Form
SAFETY GLASSES AND NO OPEN TOED SHOES REQUIRED FOR ALL CLASSES AND FACTORY TOURS

Hearing Protection encouraged
Contact Information
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
FEES
Cost to attend the St Croix CRBG event at Park Fall

$50
Pre-Pay for St. Croix rod blanks ($50.00 each, limit of 2) Blank selection based on payment! First come - first served

one Blank $50.00two Blanks $100.00
Build Your Own Blank (BYOB) Limited to those who have not participated in this activity in the last five years and only the first 15 to sign up may attend

$50
Build Your Own First Rod Class Youth (age 18 and under) are free, The adult fee is $50.

$50
Youth name for attending Build Your First Rod class

First NameLast Name
Meals and Activity Choices
I am Willing to Present a Program at this years Event

YesNo
I will bring rods to show at the event

YesNo
I Will Bring Raffle Items

YesNo
I will be entering one rod for the People's Choice Award (Regular Member)

yesno
I will be entering one rod in the Youth People's Choice Award

yesno
I will attend Wednesday night's pot luck dinner

yesno
I will attend Thursday and Friday Night's meals

yesno
I will attend Friday Noon's Pizza lunch

yesno
MY SPOUSE WILL ATTEND EVENING MEALS AND WISHES TO PARTICATE
Spouse's Name

First NameLast Name
Spouse's EMAIL:
example@example.com
DISCLAIMER: By registering for and attending any event by The Custom Rod Builder’s Build you agree that your image may at any time without further notification or compensation, be used for printed materials, web sites, social media and other marketing purposes. Further, by registering for this event, participant acknowledges that he/she
fully understands the above disclaimer and agrees to its contents.
Signed______________________________________________ Date

MonthDayYear
Date
After submitting this form please go to the website SHOP and pay any dues or fees . Registration is NOT complete until both this form and applicable fees have been submitted. Thank You!
Should be Empty: