BMHS Group Registration

"*" indicates required fields

Group Registration Price

Attendee Options*

Virtual - Student

Virtual - General

In-Person - Student

In-Person - General

# of Attendees*

Please enter a number from 10 to 25.

(10 people minimum)

Total

Finished?*

Check this box when you are finished adding Attendees below*

Credit Card*

Card Details

Cardholder Name

Attendee #1

Attendee #1 Name*

First Last

Attendee #1 Email*

Attendee #2

Attendee #2 Name*

First Last

Attendee #2 Email*

Attendee #3

Attendee #3 Name*

First Last

Attendee #3 Email*

Attendee #4

Attendee #4 Name*

First Last

Attendee #4 Email*

Attendee #5

Attendee #5 Name*

First Last

Attendee #5 Email*

Attendee #6

Attendee #6 Name*

First Last

Attendee #6 Email*

Attendee #7

Attendee #7 Name*

First Last

Attendee #7 Email*

Attendee #8

Attendee #8 Name*

First Last

Attendee #8 Email*

Attendee #9

Attendee #9 Name*

First Last

Attendee #9 Email*

Attendee #10

Attendee #10 Name*

First Last

Attendee #10 Email*

Attendee #11

Attendee #11 Name*

First Last

Attendee #11 Email*

Attendee #12

Attendee #12 Name*

First Last

Attendee #12 Email*

Attendee #13

Attendee #13 Name*

First Last

Attendee #13 Email*

Attendee #14

Attendee #14 Name*

First Last

Attendee #14 Email*

Attendee #15

Attendee #15 Name*

First Last

Attendee #15 Email*

Attendee #16

Attendee #16 Name*

First Last

Attendee #16 Email*

Attendee #17

Attendee #17 Name*

First Last

Attendee #17 Email*

Attendee #18

Attendee #18 Name*

First Last

Attendee #18 Email*

Attendee #19

Attendee #19 Name*

First Last

Attendee #19 Email*

Attendee #20

Attendee #20 Name*

First Last

Attendee #20 Email*

Attendee #21

Attendee #21 Name*

First Last

Attendee #21 Email*

Attendee #22

Attendee #22 Name*

First Last

Attendee #22 Email*

Attendee #23

Attendee #23 Name*

First Last

Attendee #23 Email*

Attendee #24

Attendee #24 Name*

First Last

Attendee #24 Email*

Attendee #25

Attendee #25 Name*

First Last

Attendee #25 Email*

Comments

This field is for validation purposes and should be left unchanged.

Attendee #1

Attendee #2

Attendee #3

Attendee #4

Attendee #5

Attendee #6

Attendee #7

Attendee #8

Attendee #9

Attendee #10

Attendee #11

Attendee #12

Attendee #13

Attendee #14

Attendee #15

Attendee #16

Attendee #17

Attendee #18

Attendee #19

Attendee #20

Attendee #21

Attendee #22

Attendee #23

Attendee #24

Attendee #25

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