Please complete ONE FORM for EACH PERSON attending

Before registering online, please read the Registration Packet

for complete information on the Gathering 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 or Sibling

This is My...

Birth Date

Death Date

Child or Sibling

This is My...

Birth Date

Death Date

Child or Sibling

This is My...

Birth Date

Death Date

Child or Sibling

This is My...

Birth Date

Death Date

Are you: (check all that apply)

Registration Fee *

Regular Registration Adult ($95)

Chapter Leader or Workshop Presenter ($75)

Student or Active Military w/ID ($50)

Thursday Meet & Greet

Thursday Meet & Greet ($20)

Meal Plan

Friday & Saturday: 2 breakfasts, 2 lunches, 2 dinners - Sunday: 1 breakfast ($199)

Individual Meals (if not choosing a Meal Plan)

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

Others

Angel of Hope Shuttle Trip ($10)

Picture Buttons

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

Sponsorship Opportunities

Gathering Program Memorial Page

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

$25 Business Card

$75 Quarter Page

$150 Half Page

$300 Full Page

Donation to 2021 BPUSA Gathering Conference in memory of child or sibling.

In memory of:

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 Gatherings.

If you are attending the 2021 Gathering, please upload a photo of your child (photo of your child only) on this form.

Not A Bereaved Parent or Sibling

I am opting out of the slide presentation

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 emailing my picture Deadline July 24th

I am mailing my picture Deadline July 1st

Child/Sibling/Grandchild's Name: *

Phonetic Pronunciation: *

Birth Date: *

Date of Death: *

Upload Picture of Child Here

I have another child

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

Child/Sibling/Grandchild's Name: *

Phonetic Pronunciation: *

Birth Date: *

Date of Death: *

Upload Picture of Child Here

A picture and completed form are needed for each child being remembered. The picture submitted must be of the child/sibling/grandchild only. Email your photo to bpusaweblinks@gmail.com no later than July 24th. . You will receive a confirming email back. If you don’t, please follow up. You don’t want to miss out having your child’s picture included in the slide presentation.

If you're mailing the photo, send photo and form to Matthew Groves, 1190 Worthington Drive, Bridgeport, WV 26330, no later than July 1st. Please put child’s name and address on the back of the photo. You can pick up your photo(s) at the Gathering Registration Table when you arrive or enclose a postage paid addressed envelope so that your photo(s) can be immediately returned to you.

When you click "Check Out", it will take you to Paypal,

where you can pay through Paypal or with a credit card.