PGDR Pre-Registration Form

Full Name*

First NameLast Name

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.

Mailing Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Conference Options

ConferenceInclusive

$150.00

Women in Power Luncheon(Bold Red & Statement Pearls) Included

$ Free Entree Choice-Select (1) from dropdown

PGER/PGDR Receiving Banquet Product Image

PGER/PGDR Receiving BanquetIncluded

$ Free Entree Choice-Select (1) from dropdown

Additional Luncheon Tickets (3 max) Product Image

Additional Luncheon Tickets (3 max)Women in Power Luncheon (If you are choosing less than 3 additional meals please select NONE FOR OPTION 2 & or 3 ) If you have NO Additional tickets DO NOT CHOOSE ANYTHING

$60.00 Quantity 2 3
Item subtotal:$0.00

Additional PGER/PGDR Receiving Banquet (3 max) Product Image

Additional PGER/PGDR Receiving Banquet (3 max)(If you are choosing less than 3 additional meals please select NONE FOR OPTION 2 & or 3 ) If you have NO Additional tickets DO NOT CHOOSE ANYTHING

$75.00 Quantity 2 3
Item subtotal:$0.00

Hero's & Villian's Themed DanceIncluded

$ Free

Total

$0.00

Payment Methods

Credit Card

Cash App Pay

If Payment is done by Zelle, Check or Money order, please use the printable version of the regisration form and MAIL TO PGDR METICH HAGAN, CONFERENCE REGISTRAR, 3605 Purebred Drive, Virginia Beach, VA 23453.

Make checks/money orders payable to NATIONAL PGDR COUNCIL.