2012 Pacific Northwest DX Convention
(Please see Disclaimers below form)
Online Registration Form (Please submit one form per person)
August 3-5, 2012, Monarch Hotel, Clackamas, OR

Name:				Callsign:
Address:
City:		State/Prov:		Zip/Postal Code:
Email:				Phone:

(All above fields are required)

Register before June 15 and receive TWO FREE grand prize tickets for one of our fabulous grand prizes.  Additional tickets will be sold at the convention.

Would you like to choose a Full Registration or A La Carte?  The full registration includes program, banquet, breakfast and prizes and costs $75.   The a la carte choice allows you to pick these items individually.

Please choose either the Full Registration or A la carte selection below, then press Continue.

Full Registration
A La Carte

Disclaimers:

1. All WVDXC online payments are processed by Paypal.   When you use your credit card to pay the convention fees, it is normal for a charge from Paypal to appear on your credit card statement.  The charge will not be from the WVDXC.
   
2. Any refunds for online convention fees are handled between you and your credit card company.  The WVDXC will allow such refunds, but you may incur a fee depending on how your payment was processed by Paypal.  If you feel you may need to cancel your convention registration in the future, it may be better to submit a paper registration form.  This is available via the links section of the DX Convention web page.