REGISTRATION FEE PER PERSON $70.00 (IN US FUNDS)
AFTER MAY 18, 2012, REGISTRATION FEE INCREASES TO $80.00 AND THERE IS NO GUARANTEE
THAT YOU WILL RECEIVE A T-SHIRT OR ANY OF THE PROMOTIONAL ITEMS THAT WILL BE GIVEN OUT AT REGISTRATION.

Please fill out one form per person. Please PRINT all names clearly.
Send the appropriate U.S. Funds as outlined below. Check or Money Orders payable to "Phlocking of the Phaithful".
Please fill out ALL of the information below. We will notify you of receipt of your registration via email if you have an email address. Otherwise, you will need to provide a self-addressed stamped envelope for verification of your registration. Any questions please email: pkaley@kaleyservice.com or pkaley@comcast.net

YOUR REGISTRATION INFORMATION:

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 $70.00 ($80.00 after May 21st) = $_______

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