HTML REGISTRATION FORM

Type in the fields below, print and mail to the address at the bottom of this page.
You may also register by fax by dowloading this form in Adobe Acrobat PDF format, or register online with Acteva.
Dewey Beach Music Conference - Individual Registration Form
 (PLEASE NOTE: SHOWCASING ARTISTS RECEIVE COMPLIMENTARY REGISTRATION AND DO NOT NEED TO FILL THIS OUT - If registering more than one person, forms must be filled out for each person.)
INDIVIDUAL REGISTRATION
Name:
Title:
Company:
Type of Business:

Mailing Address: (include city, state/province, ZIP)

Phone:
Alt Phone:
Fax:
E-Mail:
Web Site:

Non refundable registration fee of:
$35.00 postmarked by August 29th, 2004
$50.00 August 29th-September 14th, 2004
and $75.00 September 15th-September 30th (including walkup at Registration Table, day show opens)
Registration includes admission to all daytime sessions, trade show and goodie bag.
Method of Payment (Please make checks and money orders payable to Dewey Beach Fest):
Check | Money Order | Visa | Mastercard | American Express

Amount (choose one):
$35.00 Full registration (postmarked by Aug. 29th)
$50.00 Full registration (postmarked by Sept 14th)
$75.00 Walk-up (Sept 15-30)
Credit Card #:
Expiration Date:
Name as printed on Card:

Billing Address (Address, City, State Zip):

Signature: _____________________________________________________

Date:____________________
Please return registration via fax w/credit card info to 302-226-2402, or mail with payment to:

Dewey Beach Fest
P.O. Box 507
Rehoboth Beach, DE 19971
302-227-3888 (phone)
302-226-2402 (fax)