How many Delegate will attend? (Delegate Fee: $200) --Select-- - $ 0.00 Delegate 1 - $ 200.00 Delegate 2 - $ 400.00 Delegate 3 - $ 600.00 Delegate 4 - $ 800.00 Delegate 5 - $ 1,000.00 Delegate 6 - $ 1,200.00 Delegate 7 - $ 1,400.00 Delegate 8 - $ 1,600.00 Delegate 9 - $ 1,800.00 Delegate 10 - $ 2,000.00 Delegate 11 - $ 2,200.00 Delegate 12 - $ 2,400.00
How many Alternates will attend? (Alternate Fee: $200) --Select-- - $ 0.00 Alternate 1 - $ 200.00 Alternate 2 - $ 400.00 Alternate 3 - $ 600.00 Alternate 4 - $ 800.00 Alternate 5 - $ 1,000.00 Alternate 6 - $ 1,200.00 Alternate 7 - $ 1,400.00 Alternate 8 - $ 1,600.00 Alternate 9 - $ 1,800.00 Alternate 10 - $ 2,000.00 Alternate 11 - $ 2,200.00 Alternate 12 - $ 2,400.00
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for delegate 2? No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for delegate 3? No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for delegate 4 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for delegate 5 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for delegate 6 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for delegate 7 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for delegate 8 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for delegate 9 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for delegate 10 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for delegate 11 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for delegate 12 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for alternate 1 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for alternate 2 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for alternate 3 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for alternate 4 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for alternate 5 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for alternate 6 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for alternate 7 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for alternate 8 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for alternate 9 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for alternate 10 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for alternate 11 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for alternate 12 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Email *
Phone
Add contact details for Guest/Spouse/Significant Other Ticket 1 No Yes -- Select --
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Add contact details for Guest/Spouse/Significant Other Ticket 2 No Yes -- Select --
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Add contact details for Guest/Spouse/Significant Other Ticket 3 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Add contact details for Guest/Spouse/Significant Other Ticket 4 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Add contact details for Guest/Spouse/Significant Other Ticket 5 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Add contact details for Guest/Spouse/Significant Other Ticket 6 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Add contact details for Guest/Spouse/Significant Other Ticket 7 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Add contact details for Guest/Spouse/Significant Other Ticket 8 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Add contact details for Guest/Spouse/Significant Other Ticket 9 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Add contact details for Guest/Spouse/Significant Other Ticket 10 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Add contact details for Guest/Spouse/Significant Other Ticket 11 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
Add contact details for Guest/Spouse/Significant Other Ticket 12 No Yes
First Name *
Last Name *
Local Name: (Format=Stevens Point) * *
Local Number (Format=L-0484) * *
PFFW Honor Guard ($10/person suggested)
Stevens Point Fire Fighters Charitable Foundation