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Park Place Event Registration

Fields marked with an * are Required. If there is a charge for this event, please make sure you fill out Part 3 of this registration form.
STEP 1 - To be completed by all registrants:
First Name*

Last Name*

If PPS Member- Member Number
Event Name*
Event Date*
Ex. 01/10/04
  • If there is a charge for this event, Park Place Members can go straight to the Credit Card Information - PART 3 -
  • Non - PPS Members, please proceed to STEP 2.

STEP 2: To be completed by all Non-Park Place Members

              Street Address

Best time to reach you
STEP 3: If there is a charge for this event, please fill out the following.
Again, please note that this is a secure page.
Visa Flag
                 Card Number
Amount to be Charged
Expiration Date:
Name that appears on card
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