MUST BE A PBA MEMBER TO ATTEND AND PARTICIPATE

Registrant’s name __________________________________________________________________

Spouse or other family members attending ______________________________________________ __________________________________________________________________________________

Address ___________________________________________________________________________

City _______________________________________State___________________Zip_____________ Phone_______________________email_________________________________________________

2 day conference registration with lunch tickets ($100 per person) $_____________

1 day conference registration with lunch ticket (specify Saturday or Sunday) $60 $______________

2 day workshop registration with lunch tickets (Monday and Tuesday October 1 &2) $180 per person (workshop attendees are expected to bring their own hammers, safety glasses and some tools, although PBA tools will be available for use. There may additional material charges) $______________

All four days with 4 lunch tickets $260 (plus materials) $______________

Saturday Women’s social luncheon, wine, cheese, beer sampling at Too Far North, Fort Calhoun, 11:30 am – 1:30 pm $30 each $______________

PBA Annual Dues $25 $_____________

****************************EARLY BIRD REGISTRATION*************************

##### Register prior to August 1, 2018 at the following reduced rates! ##### 2 day conference with lunches EARLY BIRD $90 $_________________

2 day workshop registration with lunches EARLY BIRD $ 160 $_________________

ALL 4 DAYS – Conference, workshop and 4 lunch tickets! EARLY BIRD $225 $_________________ Total registration money enclosed. $_________________

(Spouse and minor dependents are included in conference registration fees but not lunch or workshop fees)

Please make checks payable to PBA and mail to: Clarence Mertins, 1986 McKelvie Road, Seward, NE 68434-8069

I plan to bring tailgate items to sell/swap YES _________ NO______________ I plan to bring Iron in The Hat items YES__________ NO______________

I plan on camping at Fort Atkinson YES___________ NO______________

I can help with Friday set up YES__________ NO______________

I can help with Sunday tear down YES__________ NO______________

I plan on bringing a forge, anvil and tools YES__________ NO______________

I am interested in purchasing coal @ $20/50 pound bag number of bags requested _______________

LIABILITY WAIVER FOR CONFERENCE AND WORKSHOP

Participations Liability Waiver for Two Day PBA Conference and/or Two Day PBA Workshop, Septem- ber 28 – Oct 2, 2018. Included is a check for registration in the PBA Fall 2018 Conference and/or Work- shop. Please enroll me herein. I accept the rules and requirements necessary. I also understand the blacksmithing is a potentially dangerous activity and that Prairie Blacksmith Association, its Board of Directors, Members, or any demonstrators/instructors are not held liable or responsible for my per- sonal safety or well-being, or that of any minor children attending under my supervision.

NAME (PRINT) _______________________________________________________________ SIGNATURE__________________________________________________________________ STREET__________________________________________________CITY____________________ STATE____________________________ZIP CODE________________PHONE____________________

This signed waiver is to be presented to the PBA Treasurer prior to attending the fall 2018 Conference and Workshop. Please include with paid registration.