Bouzoukia in the Burgh 2017 Registration Form

Registration Instructions:

Form Instructions

 

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
   
 
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.

 

Notes:

Select Package:

Select OnePackage NameItems IncludedPackage Cost
Bouzoukia in the Burgh Package (2017-03-17 to 2017-03-23 Price)
4/21/17 Friday Greek Night at Six Penn (2017-03-17 to 2017-03-23 Price)
4/22/17 Saturday Greek Night at Carnegie Science Center (2017-03-17 to 2017-03-23 Price)
67.75

A la Carte Items

SelectA la Carte ItemCostSubTotal
4/21/17 Friday Greek Night at Six Penn (2017-03-17 to 2017-03-23 Price) $40.00 $
4/22/17 Saturday Greek Night at Carnegie Science Center (2017-03-17 to 2017-03-23 Price) $40.00 $
   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)


What would you like to do?