20th Annual Phlocking of the Phaithful

“WRAPPING IT UP AT THE BAY – INSANITY ON THE ISLAND”
A party to remember with friends you won’t forget

Put-In-Bay, OH; June 12 – 16, 2014

Registration Form

Please mail with appropriate fees to:

Phlocking of the Phaithful
C/O Pat Kaley
169 Pinewood Drive
Bridgeville, PA 15017

ADVANCE REGISTRATION REQUIRED
DEADLINE IS SATURDAY, MAY 24, 2014

REGISTRATION FEE PER PERSON $75.00 (IN US FUNDS)
AFTER MAY 24, 2014 REGISTRATION FEE INCREASES TO $85.00

After the May 24th 2014 deadline there is no guarentee that you will receive a t-shirt and/or any other promotional items that will be given out at registration.

NAME: __________________________________________________________________

ADDRESS: _______________________________________________________________

ADDRESS: _______________________________________________________________

PHONE: _____________________________ EMAIL _____________________________

T-SHIRT SIZE(S): (2X Add $2.00, 3X Add $3.00, 4X Add $4.00 to your order for larger sizes)

___M ___L  ___XL ___2X ___3X ___4X

# OF PERSONS ATTENDING ____ x $75.00 ($85.00 after May 24TH) = $_______

Additional T-Shirt Fee of $____________________________________________

TOTAL REGISTRATION MONEY ENCLOSED: $___________________________________

PARROT HEAD CLUB AFFILIATIONS (NOT NECESSARY): _______________________________

CELEBRATING ANYTHING SPECIAL DURING THE PHLOCKING - PLEASE LIST BELOW

_____________________________________________________________________________

YOU WILL RECEIVE A FINAL AGENDA OF EVENTS AT SIGN IN AT PUT-IN-BAY

ADVANCE REGISTRATION REQUIRED

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www.phlocking.com