2016 International DX Convention Registration Form

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Registrant Information
Online Registration Ends March 31, 2016
(Pre-Registration Ends March 13th)

Please list the name(s) and call (if applicable) of each registrant.  Where applicable please indicate meal choice, if you are a "Newcomer" (first time attendee) and if you will be playing in the golf tournament.
Name Call Sign
Meal Choice
Polo Shirt
Newcomer
Golf Tourney
Name Call Sign
Meal Choice
Polo Shirt
Newcomer
Golf Tourney
Name Call Sign
Meal Choice
Polo Shirt
Newcomer
Golf Tourney
Name Call Sign
Meal Choice
Polo Shirt
Newcomer
Golf Tourney

Registration Choices
Online Registration Ends March 31, 2016
(Pre-Registration Ends March 13th)
Qty.
Description
Cost
  Qty of adult pre-registrations ends 3-13 (includes: Sat BBQ & banquet, Sun breakfast meals) ($120 ea.) $ 0.00  
  Qty of youth (under 21) registrations (includes:Sat BBQ & banquet, Sun breakfast meals) ($95 ea.) $ 0.00  
  Qty of registrations only (excludes all meals) ($35 ea.) $ 0.00  
  Qty of Saturday Tour ($40 ea.) $ 0.00  
  Qty of Convention Shirt (mens w/pocket or ladies fitted polo) with logo, name & call ($40 ea.) $ 0.00  
  Qty of Attitude Adjustment Hour Drinks Sponsored ($5 ea.) $ 0.00  
Total
Enter quantity for each item.  

$0.00

Payment Information
Required fields are marked with an *
* First Name:
* Last:
* Address 1:
Address 2:
* City:
State/Pr:
* Postal Code:
* Country:

Phone:
* Email:
Special Instructions:  

Click here to print this form and
mail with your check to:

Kris Jacob, KC6TOD
P.O. Box 5565
Fullerton, CA 92835-5565

Click here if you would like to pay on-line using a credit/debit card or PayPal.


You will have a chance to return here to make corrections if anything is wrong.