Bouzoukia in the Burgh Registration Form (DCGreeks.com)

Registration Instructions:

If you wish to pay by credit card (American Express, Discover, MasterCard, or Visa) or PayPal using our secure payment processing page, please complete the following form for each individual registrant whose registration fee will be paid by a single credit card or PayPal transaction.
(This method is preferred for ease of processing.)
- Clicking the "Complete Registration by Credit Card or PayPal" button on the registration confirmation page will take you to our secure payment processing page for you to complete your billing information and process the payment. Please make sure the email address you enter on that page matches the email address entered on this registration form.
If you wish to pay by check, you can:
- Complete the secure online form below.
  - Upon submitting the form, you will be taken to a printer friendly page for you to print out 2 copies of the completed form.
  - Mail one copy of the form along with a check made payable to "Maids of Athena, Chapter #56" to
         Maids of Athena, Chapter #56
         220 Littell Rd
         Aliquippa, PA 15001
    This will allow the processor to match your check with your registration(s).
  - Keep the other form for your records.
All registrations are considered final once payment is submitted. No refunds will be issued if the registrant chooses not to attend the event.

Form Instructions

If registering more than one person on a single credit card/check, make sure to enter the payer's registration information first before entering information for additional registrants.
If you experience any issues while submitting your credit card payment or completing your registration, do not resubmit your payment/registration. Please email [email protected] for assistance.
Any other questions or issues, please email [email protected] .

Email Address Confirm Email Address

* * * *

First Name Middle Last Name Suffix

* *

Street Address (Line 1)

*

Street Address (Line 2, if applicable)

City State ZIP

* * *

Date of Birth (mm/dd/yyyy) Gender

* *

Female
Male

*

Home Phone Mobile Phone

*

Emergency Contact's Name Emergency Contact's Phone

* * *

How many previous
Pan-Hellenism Weekends
have you attended? (max 6) How did you find out about this event?
(If other please specify)

* * *

When are you arriving? How are you getting here? When are you leaving?

* * * * * *

Will you need bussing to local events? T-Shirt Size

* *

LIABILITY WAIVER

I expressly acknowledge that I am holding harmless the organizers and consponsors of Bouzoukia in the Burgh 2017 (including but not limited to the Sons of Pericles and Maids of Athena, its members, employees, managers, owners and agents, and all their collective officers, directors, contractors, agents, employees, and volunteers, without regard to any negligence on their part, against any claim for injuries, damages, compensation or otherwise, including all losses and expenses, caused by or to me in registering for or participating in Bouzoukia in the Burgh 2017. I voluntarily assume the risk of injury, accident, death, loss, cost or damage to my person or property that might arise from my registration for and/or participation in Bouzoukia in the Burgh 2017 or any related events. My refusal to agree to the terms of this waiver will result in my exclusion from all events and my registration fees being refused or refunded. I understand that my registration will not be accepted without this acknowledgement.

I acknowledge and agree to these terms. *

Notes:

Select Package:

Select One Package Name Items Included Package Cost

A la Carte Items

Select A la Carte Item Cost SubTotal
Total A la Carte Item Cost: $

Total Cost for this Registration: $ *

To help the organizers better plan for the events taking place during Bouzoukia in the Burgh, please select all of the events which you are interested in attending. (Check all that apply)

4/21/17 Friday Greek Night at Six Penn 4/22/17 Saturday Greek Night at Carnegie Science Center
4/22/17 Basketball Tournament at Brashear High School 4/23/17 Basketball Tournament at Brashear High School

What would you like to do? *

Add Another Person to the same Registration Payment
Done Registering

How many previous Pan-Hellenism Weekends have you attended? (max 6)	How did you find out about this event?	(If other please specify)
* *	*
When are you arriving?	How are you getting here?	When are you leaving?
* *	*	* * *

Select	A la Carte Item	Cost	SubTotal
		Total A la Carte Item Cost:	$