Bereaved Parents of the USA

Gathering Registration
This registration form is for those who would like to make their payment online with a credit card or PayPal payment. Clicking on the NEXT button at the bottom of this form will take you to another page where you will register and select meals and then you will be directed to a secure PayPal cart to submit your payment information.

If you prefer to send in a check, please print and complete the Gathering packet in pdf pdf and mail it with your payment to Bill Lagemann, PO Box 112, Clarksville, MO 63336.

Please make certain to download the registration packet pdf and read the very useful information on the event. The packet has information on travel, registration and the many events taking place at the Gathering.

Your personal information will be used for no other purpose than for your registration at the Gathering.

For questions regarding registration, call Bill at 573-242-3632 or email wglroom@gmail.com.

* Red asterisk indicate required fields

Your Name *
Address *
City * State *
Zip Code *
Phone Number *
E-mail Address *
Email Address confirm *
Is Registrant a bereaved sibling? *
Is Registrant a Speaker?  *
Gathering Registration for the 2014 National Gathering is $45.00 per person, maximum $125.00 per family. After June 1st, the registration fee is $60.00 per person, $165.00 maximum per family (3 or more).Please register as EARLY as possible for planning purposes, and to get the BIGGEST SAVINGS on fees and airfare!"
Are you registering for a family group? *
Registration, Number Attending
Additional Names of those attending, their relationship to you (spouse or child) and if child, their age.
Information on deceased child(ren)
Child's Name
Phonetic spelling
Birth Date
Death Date
Please include in slide presentation
Relationship to Child

Child's Name
Phonetic spelling
Birth Date
Death Date
Relationship to Child
Please include in slide presentation

Child's Name
Phonetic spelling
Birth Date
Death Date
Relationship to Child
Please include in slide presentation
Slideshow Presentations
Slide Presentation Pictures

 
more info

Slideshow Presentation After you have completed registration, a page will open with a link to a form and instructions for mailing Or Email the slideshow form from Registration packet and your picture to matthew.lane.groves@gmail.com and put “Slide Show” in the subject line.
For additional information see page 6 of the registration packet.

The form and picture(s) must be mailed
NO LATER THAN JULY 1, 2014
Matthew Groves 1190 Worthington Drive Bridgeport, WV 26330
Or Email the form from Registration packet and the picture(s) to matthew.lane.groves@gmail.com.

Meals
           
Meal Plan Pricing:
- Adult Meal Plan $150
- Child Meal Plan $75 (12 and under)
Individual Meal Pricing:
- Adults
- Children
Adult Meals Friday Breakfast, Adult $20
Child Meals Friday Breakfast, Child $10
    Friday Lunch, Adult $24
    Friday Lunch, Child $12
    Friday Dinner, Child $17
    Friday Dinner, Adult $34
    Saturday Breakfast, Adult $20
    Saturday Breakfast, Child $10
    Saturday Lunch, Adult $26
    Saturday Lunch, Child $13
    Saturday Dinner, Child $15
    Saturday Dinner, Adult $30
    Sunday Breakfast, Adult $20
    Sunday Breakfast, Child $10
More information on meal plan options
Special Diet Needs and/or Food Allergies (please explain in detail)
Sponsoring and Ordering
I am sponsoring

Your CHILD’s Name as you want it on the sign
 
Memorial Sponsor Ad
Notes about your memorial page
 
I am ordering

 

more info

Workshop or Session: For $50, a sign will be professionally made which will include your child’s name, photo, your name and the name of the workshop or sharing session.  The sign is yours to keep at the conclusion of the Gathering. See page 3 of the registration packet.

Centerpiece: For a $35 donation, your child’s name and photo will be displayed with the centerpiece at every meal and is yours to keep at the conclusion of the Gathering.  See page 3 of the registration packet.

BP/USA Chapter Leadership Training
BP/USA will conduct training workshops all day on Thursday, July 25 for BP/USA chapter leadership.
Chapter Leader Attending
Chapter Affiliation,
if any
Responsibility
I will attend Chapter Leadership Luncheon
Please specify any special dietary needs: for the chapter leadership luncheon
  Additional information on CLT

Hotel Accommodations
Please check all of the dates that you will be registering at the hotel for the Gathering. This information is for our records only.
Please make your own hotel reservations directly with the Sheraton Clayton Plaza. Click here for BP/USA Group rate reservations at the Sheraton Clayton Plaza Hotel St. Louis.   The deadline to make your reservation at the discounted hotel room rate is July 4th - don't miss out!  Our negotiated room rate is $86.00/night per room for single or double occupancy.

Dates of the Event, select all that apply
Dates Before Event

Dates of the Event, select all that apply

Dates After the Event

Registration Payment
You will automatically be redirected to our paypal shopping cart to pay.  (PayPal is a secure way to pay over the internet). If you prefer to pay by check, please check this box and print the order form from the registration packet pf to total your order and mail in with the check and check the following box.
Additional Information
Please include above any physical limitations, if you are confined to a wheelchair,
or if you are hearing impaired and need an interpreter and any additional information
that we should be aware of. Thank you.