Registration - $25.00 per person:
(After June 14th, registration increases to $30.00 per person)

First Name
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
E-mail

          Do you plan to purchase a t-shirt for $12.00?

          Yes No

What size shirt would you like?

Medium Large X-Large XX-Large XXX-Large

To complete your order and pay via PayPal, click the "Submit Form" button now.

If you prefer to send your order with a check, please print this page and mail it with your payment to:

GPA-MoKan
936 S. Pope
Independence, MO 64050

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