Bereaved Parents of the USA

A word on the tragic deaths of our brave men and women of the Armed Forces...

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. There is much 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 501-847-4102 or email BPUSA2010registration@yahoo.com

* Red asteriks mark required fields

Your Name *
Address *
City *
State *
Zip Code *
Phone Number *
E-mail Address *
Name of Child
Birthdate
Death Date
Relationship to Child
Please include child in slide presentation	Yes	No
Name of Child
Birthdate
Death Date
Relationship to Child
Please include child in slide presentation	Yes	No
Name of Child
Birthdate
Death Date
Relationship to Child
Please include child in slide presentation	Yes	No

Slide Presentation Pictures, please check one	The picture(s) is in your file I am mailing/emailing a picture(s) Click here to see mailing/email info or follow link at end of registration Please include my child/children without a picture

Registration for the 2010 National Gathering is $35 per person, maximum $85 per family.
Registration, Number Attending
Names of those attending
Please list names of those needing vegetarian meals
Other special dietary request, please specify

BP/USA Leadership Training BP/USA National will hold a Luncheon and Leadership Training the afternoon of Thursday, July 8.
Attending	Yes	No
Please complete the CLT application available at end of the registration following payment.
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 reservations directly with the Little Rock Holiday Inn Airport Conference Center, at 1-800-HOLIDAY. Deadline to register at the discounted rate is June 17 - don't miss out!
Dates Before Event	Monday, July 5 Tuesday, July 6 Wednesday, July 7
Dates of the Event, select all that apply	Thursday, July 8 Friday, July 9 Saturday, July 10
Dates After the Event	Sunday, July 11 Monday, July 12 Tuesday, July 13 Wednesday, July 14

Additional Information