2012 Ittawamba Gold Card

* I have read and agree to the Requirements concerning The Card, including the fact that I will owe any difference for the Conclave fee if the Early Bird fee is more than $30.
It is recommended you print the information for your records.
* I further understand that if I do not properly pre-register during the Pre-registration Period, I agree to pay the difference between the Walk-On and Pre-registration fee. Phone orders will not be accepted.
* Name:
* Unit:
* Date of Birth:
* Home Phone #:
* 2012 Ittawamba Gold Card
Please type the number "1" in the box below. 		 ×  = $