GRUE in the Lou 2
Sponsors: PEP-STL, STLRopeworks, and MO-FLOG

Yes, I want to register for Graydancer's Ropetastic Unconference Extravaganza!

?	Registration is not complete until payment and all pages of your signed registration/release form are received.
?	Registration date determined by postmark.
?	Registration must be postmarked by June 19, 2009
?     Make your check or money order payable to PEP-STL and mail to:

PEP-STL
427 Estelle Ave
Ferguson, MO 63135


#1 Registrant
Legal Name________________________________________________
Address___________________________________________________
City/State/ZIP____________________________________________
Email Address___________________________ (for confirmation)
Phone___________________________________________ (optional)
Put this name on my Badge_________________________________


#2 Registrant
Legal Name________________________________________________
Address___________________________________________________
City/State/ZIP____________________________________________
Email Address____________________________(for confirmation)
Phone____________________________________________(optional)
Put this name on my Badge_________________________________


Registration fee #1: $25
Registration fee #2:    
             Total :    



___Agree: I hereby affirm that I am 21 years of age or older and that I agree to hold harmless and indemnify PEP-St. Louis, F.L.O.G.,  STLRopeworks, Graydancer, the event venue, and any and all of their employees, officers, directors, agents and, or assigns from any and all liability, direct, indirect, subrogated or not, vicarious, or otherwise, which may accrue as a result of any accident, injury, cause of action, or damage to my person or property, or any other damage of any kind as a consequence of my attendance at this event.

___Agree: I affirm that I am registering under my legal name; I understand that I will be required to provide photo ID and that my registration may be canceled without refund or other consideration if I have not registered under my legal name or if I have attempted to purchase someone else's registration. I understand that the event organizers reserve the right to refuse or to refund any registration for this event, and if that occurs my payment will be refunded in full. 

___Agree: I hereby certify that I am not an employee of any law enforcement agency, or that if I am, I am attending this event solely for my personal enjoyment and not as part of any investigation. I certify that I am not a member of the media, or that if I am, I am attending this event solely for my personal enjoyment and not as part of any investigation or gathering of information and that I will not use any such information in any manner without the express written permission of the organizers.

___Agree: I agree that everything that I observe here will be kept in strict confidence, and that I will do nothing to jeopardize the privacy and identities of any other attendees without the expressed written permission of the organizers. I certify that I am attending this event for my personal enjoyment and that I understand that in so doing I will be exposed to activities that some people might find offensive, but I hereby certify that I do not find such activities offensive and that I consent to being exposed to such activities at this event. 

___Agree: I further agree to abide by all F.L.O.G. Dungeon Rules, as listed at http://moflog.org/rules

1st Registrant Legal Signature ____________________________

Day __ Month ________, 2009 
 

2nd Registrant Legal Signature ____________________________

Day __ Month ________, 2009