Bereaved Parents of the USA
2012 Gathering
Gathering 2012
Now Available

Hotel Registration
Information

Workshop Presentor Application
MS Word Word | PDF pdf
Online Application

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to the 2012 Gathering


Gathering Registration Online
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 and mail it in with your payment.

Please make certain to download the registration packet 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 703-910-6277 or email bpusa.nova@yahoo.com - additional contact information.

* Red asteriks mark required fields

Your Name *
Address *
City *
State *
Zip Code *
Phone Number *
E-mail Address *
Retype Email Address *
Information on deceased child(ren)
Name of Child
Birthdate
Death Date
Relationship to Child
Please include child in slide presentation
Name of Child
Birthdate
Death Date
Relationship to Child
Please include child in slide presentation
Name of Child
Birthdate
Death Date
Relationship to Child
Please include child in slide presentation
Slideshow Presentations
Slideshow Presentation Pictures,
please check one

more info

Slideshow Presentation After you have completed registration, a page will open with a link to a form and instructions for mailing or emailing your child(ren)'s picture(s) for the slideshow presentation.

The form and picture(s) must be mailed
NO LATER THAN JUNE 25, 2011
BP/USA NOVA Chapter
P.O. Box 7675 Woodbridge, VA 22195
Or Email the form from Registration packet and the picture(s) to bpusa.nova@yahoo.com.
Sibling Slideshow Presentation
more info

Sibling Slideshow Presentation
We will have a special sibling slideshow presentation separate from the Candlelight Service.  Siblings who wish to be included should also send pictures of themselves with their sibling(s) sharing special moments.


Gathering Registration for the 2011 National Gathering is $35.00 per person, maximum $90.00 per family.

Please register as EARLY as possible for planning purposes, and to get the BIGGEST SAVINGS on fees and airfare!"
Registration,
Number Attending
Names of those attending
Please list names of those needing vegetarian meals
Other special dietary request, please specify
 

BP/USA Chapter Leadership Training
BP/USA will conduct training workshops all day on Thursday,
July 28 for BP/USA chapter leadership.
 
more info on CLT
BP/USA Chapter Leaders, core group/steering committee members, newsletter editors, treasurers, etc. interested in learning new ideas and the workings of a chapter, should plan on attending the chapter leadership training and luncheon on Thursday July 28th.  Track I is an all-day workshop for new chapter leaders and those taking new leadership roles, covering all aspects of setting up and running a chapter – it begins at 9:00 am. Track II has specific-topic workshops for current leaders – it begins after lunch.  Attendees of both training tracks will join together for lunch that day.

I will attend


Chapter Affiliation
Responsibility in Chapter
I will attend
I will attend the 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 Reston Hotel, Reston, Virginia / Washington DC, at (703) 620-9000. Deadline to make your reservation at the discounted hotel room rate is June 26th - don't miss out!
Dates Before Event

Dates of the Event, select all that apply

Dates After the Event



 
Additional participation
I am ordering
I am sponsoring
 
If you would like to donate table favors, please indicate what you would like to provide:
 
 
more info on table favors

Table Favors
If you, your chapter, or organization would like to donate small table favors in memory of your child(ren), we need approximately 400 (possibly as many as 500) items per meal.  Indicate in the box above what you would like to donate, or contact Linda Harkness at (703) 530-6496 or bpusa.nova@yahoo.com.  You may bring the items with you to the Gathering or mail them to Linda at 7694 Knightshayes Dr., Manassas,VA 20111.
Questions, Comments or Additional Information