83rd PFFW State Convention Registration Form

All delegates and alternates registration are required to manage attendees. Guests attending proceed to the end of the registration form and enter your guest(s) name and Local's name.

How many Delegate will attend? (Delegate Fee: $200)

How many Alternates will attend? (Alternate Fee: $200)

CANCELED:How many Spouse/Significant others will attend? (CANCELED)

CANCELED: Due to lack of interest, all events Spouse events have been canceled

How many Guest(s) will attend?

Go to Guest/Spouse/Significant Others at the bottom of the form to enter their name.

How many will attend the President's Reception & Beer Garden (Free)

Please register to ensure we have the appropriate count on food

Delegate Contact Information

Each Delegate will have to bring a photo ID with them to registration.

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for delegate 2?

Delegate 2 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for delegate 3?

Delegate 3 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for delegate 4

Delegate 4 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for delegate 5

Delegate 5 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for delegate 6

Delegate 6 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for delegate 7

Delegate 7 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for delegate 8

Delegate 8 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for delegate 9

Delegate 9 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for delegate 10

Delegate 10 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for delegate 11

Delegate 11 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for delegate 12

Delegate 12 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Alternate Contact Information

Each Alternate will have to bring a photo ID with them to registration.

Add contact details for alternate 1

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for alternate 2

Alternate 2 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for alternate 3

Alternate 3 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for alternate 4

Alternate 4 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for alternate 5

Alternate 5 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for alternate 6

Alternate 6 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for alternate 7

Alternate 7 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for alternate 8

Alternate 8 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for alternate 9

Alternate 9 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for alternate 10

Alternate 10 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for alternate 11

Alternate 11 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Add contact details for alternate 12

Alternate 12 details

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Email *

Phone

Address

Address Line 1

City

State

Zip Code

Guest/Spouse/Significant Other Ticket

Registration fee will include a private breakfast located in the Top Shelf Lounge, Wine & Painting Event, Wellness Spa treatment...and a few more events that are being finalized. *Events are subject to change without notice*

Add contact details for Guest/Spouse/Significant Other Ticket 1

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Add contact details for Guest/Spouse/Significant Other Ticket 2

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Add contact details for Guest/Spouse/Significant Other Ticket 3

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Add contact details for Guest/Spouse/Significant Other Ticket 4

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Add contact details for Guest/Spouse/Significant Other Ticket 5

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Add contact details for Guest/Spouse/Significant Other Ticket 6

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Add contact details for Guest/Spouse/Significant Other Ticket 7

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Add contact details for Guest/Spouse/Significant Other Ticket 8

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Add contact details for Guest/Spouse/Significant Other Ticket 9

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Add contact details for Guest/Spouse/Significant Other Ticket 10

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Add contact details for Guest/Spouse/Significant Other Ticket 11

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Add contact details for Guest/Spouse/Significant Other Ticket 12

First Name *

Last Name *

Local Name: (Format=Stevens Point) * *

Local Number (Format=L-0484) * *

Donations

PFFW Honor Guard ($10/person suggested)

Stevens Point Fire Fighters Charitable Foundation

Make Checks Payable to Local 484, Memo: 83rd PFFW Convention

Pay by Check
Pay by Credit/Debit Card

If paying by check, click the box and submit. Your registration will be submitted, then print the PayPal summary, and close out of the PayPal payment form when it opens. Mail your payment to: Local 484, P.O. Box 484, Stevens Point, WI 54481

Total

$0.00

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83rd PFFW State Convention Registration Form