Event registration
This form is to register for Black River Book Bash in Poplar Bluff Mo.

Date: August 5th

Time: set up starts at 8am and we will open to readers (the public) at 9:30am

Venue: Black River Coliseum

I will send invoices for the deposit of half the cost of table (must be paid with 48 hours of receipt) with the remaining balance of the final half due July 15th.

Name *
Your answer
Email (where you receive your email) *
Your answer
Pen name if different from legal name *
Your answer
Paypal Id *
Your answer
Will you need a hotel room ( I will be trying to negotiate a lower rate) *
Table Size *
Required
Are you an: *
If you selected other from above please state who you are with.
Your answer
I understand and agree that when I pay the deposit that it is non-refundable. If I do not pay the remaining balance when due I will lose my spot and my deposit *
Required
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