Online Registration (Credit/Debit Cards ONLY)

What is your first name?

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* 1. What is your first name?

What is your last name?

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* 2. What is your last name?

What is your street address, including city, state and zip?

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* 3. What is your street address, including city, state and zip?

What is a phone number where you can be reached?

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* 4. What is a phone number where you can be reached?

Enter an email address below where invoice should be sent.

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* 5. Enter an email address below where invoice should be sent.

  • Basic Registration $25 - includes Friday Dance
  • Comedy Show Ticket (prepaid) $10
  • Saturday Dance $5
In the response field below, please enter how many and what you would like to register for:
(e.g. 1 Basic Registration, 1 Comedy Show, etc)

(Note: You will receive an invoice from Square to pay your registration fees. Once the invoice is sent you have 24 hours to pay the invoice or your registration will be CANCELLED and you will need to register again.)

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* 6. In the response field below, please enter how many and what you would like to register for:
(e.g. 1 Basic Registration, 1 Comedy Show, etc)

(Note: You will receive an invoice from Square to pay your registration fees. Once the invoice is sent you have 24 hours to pay the invoice or your registration will be CANCELLED and you will need to register again.)

Do you have any special needs that require special accommodation?

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* 7. Do you have any special needs that require special accommodation?

 
Thank you for registering for COACNA XXVII, January 5-7, 2018, Columbus Ohio

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