DBMC 2006 INDIVIDUAL REGISTRATION FORM

Type in the fields below, print and mail with other materials (see required submission materials below) to the address at the bottom of this page.
You may also register by dowloading this form in Adobe Acrobat PDF format, or register securely online with Acteva.

PLEASE NOTE: SHOWCASING ARTISTS RECEIVE COMPLIMENTARY REGISTRATION AND DO NOT NEED TO FILL OUT THIS FORM - If registering more than one person, forms must be filled out for each person.

Name:
Title:
Company:
Type of Business:
Address:
City:
State:
Zip Code:
Phone:
Alt Phone:
Fax:
Email:
Website:

Non-refundable registration fee of:
$35.00 postmarked by August 29th, 2006
$50.00 August 29th-September 14th, 2006
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 Deweybeachfest):
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 Number:
Expiration Date:
Name as it appears on card:
Billing Address:
City:
State:
Zip Code:

Signature: _____________________________________________________

Date:____________________

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

Deweybeachfest
109 Dickinson St,
Dewey Beach, DE 19971
(302)-227-3888 (phone)
(302)-226-2402 (fax)