2023 BPUSA NATIONAL GATHERING CONFERENCE

JULY 21 – 23, 2023

Hilton Washington Dulles Hotel,

Herndon, Virginia 20171

Please complete ONE FORM for EACH PERSON attending. Before registering online, please read the Registration Packet for complete information on the Gathering Conference Weekend.

Save & Return (Optional)

Don't think you will have time to fill this whole thing out in one setting? Sign in now, fill out as much as you can and hit save progress below and complete this form later.

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Phone (add dashes) *

Email Address *

Child/Sibling/Grandchild

This is My...

Birth Date

Death Date

Child/Sibling/Grandchild

This is My...

Birth Date

Death Date

Child/Sibling/Grandchild

This is My...

Birth Date

Death Date

Child/Sibling/Grandchild

This is My...

Birth Date

Death Date

Are you: (check any or all that apply)

Newly Bereaved (less than 3 years)

No Other Surviving Children

Bereaved Sibling

First Time Gathering Attendee

Not A Bereaved Parent, Sibling, or Grandparent

Registrant Age Range (please check one): *

Do you require parking for your privately owned vehicle or rental car? *

Yes

No

Registration Fee *

Regular Registration Adult (After June 1st $95)

BPUSA Chapter Leader or Workshop Presenter (After June 1st $75)

Student or Active Military W/ID ($50)

Already Registered

Thursday Meet & Greet Reception

Thursday Meet & Greet Reception ($25)

Meal Plan

Friday & Saturday: 2 breakfasts, 2 lunches, 2 dinners - Sunday: 1 breakfast ($235)

Individual Meals (if not choosing a Meal Plan)

Special Diet Needs and/or Food Allergies (explain in detail)

Picture Buttons

# of Picture Buttons $5 each (slide presentation photo will be used for picture button)

Sponsorship Opportunities

Gathering Program Memorial Page. Please upload your photos or print-ready layout using the Memorial Page Sponsorship Form on our website.

Gathering Program Memorial Page 1/4 page ($25)

Gathering Program Memorial Page 1/2 page ($50)

Gathering Program Memorial Page full page ($100)

Gathering Program Business Ad. Please upload your print-ready ad on the Business Ad Sponsorship Form on our website.

$25 Business Card

$75 Quarter Page

$150 Half Page

$300 Full Page

Donation to BPUSA in memory of my child, sibling, grandchild.

In memory of:

I'm willing to volunteer for the following:

Current Total:

$0.00

Payment Method *

Credit Card

Pay Pal

Check

Memorial Slide Presentation Form

The slideshow presentation during the Candlelight Service is a meaningful part of our weekend.

If you are attending in 2023, please upload a photo of your child, sibling, or grandchild (alone in the photo) on this form.

Not A Bereaved Parent, Sibling, or Grandparent

#1 Child/Sibling/Grandchild's Name: *

Phonetic Pronunciation: *

Birth Date: *

Date of Death: *

Slideshow Presentation Photo: *

The photo should be on file from a past National BPUSA Gathering Conference.

Include NAME ONLY with an appropriate representation (no photo available).

I am uploading my picture

I am emailing my photo and my Memorial Slide Presentation Form Deadline July 9th

I am mailing my photo and my Memorial Slide Presentation Form Deadline July 1st

I prefer that No Photo is used for the Memorial slideshow presentation during the Candle Lighting Ceremony

Upload Picture of Child, Sibling, Grandchild Here (File name will appear under the browse button.)

I have another child/grandchild/sibling.

#2 Child/Sibling/Grandchild's Name: *

Phonetic Pronunciation: *

Birth Date: *

Date of Death: *

Slideshow Presentation Photo:

The picture should be on file from a past gathering.

Include my child's NAME ONLY with appropriate representation (no photo available).

I am uploading my child's picture

I am mailing/emailing my picture

I prefer that No Photo is used for the Memorial slideshow presentation during the Candle Lighting Ceremony

Upload Picture of Child, Sibling, Grandchild Here (File name will appear under the browse button.)

#3 Child/Sibling/Grandchild's Name:

Phonetic Pronunciation:

Birth Date:

Date of Death:

Slideshow Presentation Photo:

The picture should be on file from a past gathering.

Include my child's NAME ONLY with appropriate representation (no photo available).

I am uploading my child's picture

I am mailing/emailing my picture

Upload Picture of Child, Sibling, Grandchild Here (File name will appear under the browse button.)

#4 Child/Sibling/Grandchild's Name:

Phonetic Pronunciation:

Birth Date:

Date of Death:

Slideshow Presentation Photo:

The picture should be on file from a past gathering.

Include my child's NAME ONLY with appropriate representation (no photo available).

I am uploading my child's picture

I am mailing/emailing my picture

Upload Picture of Child, Sibling, Grandchild Here (File name will appear under the browse button.)

#5 Child/Sibling/Grandchild's Name:

Phonetic Pronunciation:

Birth Date:

Date of Death:

Slideshow Presentation Photo:

The picture should be on file from a past gathering.

Include my child's NAME ONLY with appropriate representation (no photo available).

I am uploading my child's picture

I am mailing/emailing my picture

Upload Picture of Child Here (File name will appear under the browse button.)

If you choose to use the Memorial Slide Presentation Mail-In Form instead of uploading your photo here, you will find the form in the Registration and Information Packet on our website. Please complete the Form and send it and your photo to Matthew Groves by email (by July 9) or U.S. mail (by July 1) to the address listed on the form. If you do not receive a confirmation of receipt by email, please follow up to be sure we have received it.

When you click NEXT, you can go to PayPal, where you can pay by credit card or PayPal, or you can choose the option to PAY BY CHECK.

15-17
18-24
25-34
35-44
45-54
55-64
65 and older
prefer not to respond