PNR / PCR / NMRA
Siskiyou Summit 2012
May 2 - 5, 2012
Red Lion Hotel, Medford, Oregon
Online Registration Form
YES! Sign me up!
NOTE:
Only your registration information will be entered on this form. Your payment information will be entered on PayPal's secure website, following submission of this form.
If paying by check, please do NOT use this Form. Use the
Mail-in Registration Form
instead.
No refunds after April 1, 2012.
* Indicates Response Required
PRIMARY REGISTRANT INFORMATION
Convention Registration #:
(If new, leave blank)
*
Last Name
*
First Name
*
Badge Name
*
NMRA Region
*
NMRA #
MMR #
*
Address
Additional Address Information
*
City
*
State or Province
*
ZIP or Postal Code
*
Telephone
*
Country
*
e-Mail Address
*
Re-enter e-Mail Address
*
Registration Type (Select one)
Model Railroader
Sidetrack
Youth
Primary Scales and Interests (Select all that apply)
HO
N
O
S
G
Narrow Gauge
LDSIG
OPSIG
Other
OTHER IMPORTANT STUFF:
I can Volunteer on:
Wednesday
Thursday
Friday
Saturday
I can help more!
Have Volunteer Coordinator contact me
ADDITIONAL REGISTRANT LIVING AT SAME ADDRESS
(If more than one, finish this form and submit another Online Registration Form)
Last Name
First Name
Badge Name
NMRA #
MMR #
e-Mail Address (If different than above)
Re-enter e-Mail Address
Registration Type (Please check one)
Model Railroader
Sidetrack
Youth
Primary Scales and Interests (Check all that apply)
HO
N
O
S
G
Narrow Gauge
LDSIG
OPSIG
Other
OTHER IMPORTANT STUFF:
I can Volunteer on:
Wednesday
Thursday
Friday
Saturday
I can help more!
Have Volunteer Coordinator contact me!
COMMENTS:
If you have previously registered, please tell us why you are submitting
another Registration Form. Thank you.
Pressing the "
Submit
" button below will send your information to the Registrar via e-mail, then take you to our "Ticket Office" page to pay for your registration(s) and other extra-fare items using PayPal's secure shopping cart.
*
Indicates Response Required
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