PAGAN ODYSSEY 2011
EARLY BIRD SPECIAL
Attendee Registration Form
ATTN: VENDORS! PLEASE USE THE VENDORS CONTRACT!
Please print this form and mail it to:
PAGAN ODYSSEY
c/o The Panthean Temple
POB 111
Derby, CT 06418
Email: PaganOdyssey@aol.com
Phone: 203-660-1369 VoicemailPLEASE NOTE:
We do not send out tickets, your registration form will be on file at the gate.
Use one form for each Family attending, use both adult's names on this form.
You will be required to sign a waiver when you arrive.
Please bring photo ID that clearly states your age.List All Names: _________________________________________________________________________________________
Address: ___________________________________________________________________________________
City: ______________________________________________________________________________________
State: _____ Zip Code: ___________
Phone Number: (___) ____-______
Email Address: ________________________________ADMISSION
# of Adults attending: _________ @ $85.00 Each ___________
# of Children Child ages 5-17: _________ @ FREE ___________
# of Children ages under 5: _________ @ FREE ___________Prices increase November 1st!
FLAT RATE WEEKEN ADMISSION ONLY!
NO DISCOUNTS IF YOU ARE NOT CAMPING!
ADMISSION DOES NOT INCLUDE FOOD, NO MEAL PLANS!
IF YOU CANNOT AFFORD ADMISSION, PLEASE CONSIDER BECOMING A VOLUNTEER!
WE DO NOT OFFER SCHOLARSHIPS!Make checks payable to: Panthean Temple
Please write the full names of those attending on the back of this form, along with the children's ages.Are there any special problems that our staff need to be aware of (ie: medical conditions, etc.)? Please let us know, we will do our best to accommodate your needs.
____________________________________________________________________________
____________________________________________________________________________Emergency Contacts and Phone Numbers:
____________________________________________________________________________
____________________________________________________________________________By signing this registration form, I the undersigned, do acknowledge that the registration fee is non-refundable, except if this event is cancelled (which would require an act of Goddess). I agree to abide by the rules and regulations, as well those that apply to vending specifically, I have read them on this web site, and understand that I may be removed from the event for any violation of these rules.
Signed: _____________________________________ Date: _____________________