NOTE: This web page is protected by 128 Bit Secure Socket Layer Technology ("SSL"). This is an advanced encryption technique conforming to industry "Best Practice". It ensures secure data transfer between your browser and the secure server. When your web browser is set to its defaults, a small yellow lock in the status line of your browser will appear.

Look for the Lock on the bottom right tool bar.    

Park Place Event Registration

Fields marked with an * are Required. If there is a charge for this event, please make sure you fill out Part 3 of this registration form.
 
STEP 1 - To be completed by all registrants:
First Name*

Last Name*

If PPS Member- Member Number
Event Name*
Event Date*
Ex. 01/10/04
   
  • If there is a charge for this event, Park Place Members can go straight to the Credit Card Information - PART 3 -
  • Non - PPS Members, please proceed to STEP 2.

STEP 2: To be completed by all Non-Park Place Members

              Street Address

City
State
Zip
Phone
Age
Best time to reach you
Email*
 
STEP 3: If there is a charge for this event, please fill out the following.
Again, please note that this is a secure page.
Credit/Type
Visa Flag
                 Card Number
Amount to be Charged
  $
Expiration Date:
Month
Year
Name that appears on card
   
 
Powered by NLDWeb Hosting © 2003, 2004 NewLogic Designs