LonestaRG-21 Registration - Central Texas Mensa

Central Texas Mensa

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Click here for a PDF Print form to register by mail.
Email: lonestarg@lsm.us.mensa.org

LonestaRG XXI REGISTRATION

* Indicates required field

Name *

First

Last

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Options *

Please don't list my city/state on the RG web site attendee list Please don't include me on the list of RG attendees made available to RG-goers

Badge Name 1 *

Badge Name 2 *

Badge Name 3 *

Badge Name 4 *

Number of Adults ($90 through 6/15/19, $100 through 7/13/19) *

Do you have a discount code? Please enter here! *

Number of Attendees Ages 9-20 ($45 through 6/15/19, $50 through 7/13/19) *

Number of First-Time LonestaRG Attendee Adults ($65 through 6/15/19, $75 through 7/13/19) *

Number of First-Time LonestaRG Attendee Ages 9-20 ($32.50 through 6/15/19, $37.50 through 7/13/19) *

Number of Children 0-8 (Free) *

Are you interested in volunteering for: *

Hospitality Solicit Donations Speaker Assistant Prepare Food Bring Games Logistics/Purchasing Registration Other

Any Comments? *

When you hit submit, you'll be taken to a page with a PayPal link. Click that to go to PayPal. You'll need to enter the total on the PayPal page -- right now we don't have the capability to transfer cost from this page to the PayPal page.

Submit

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