Online Registration Return to Main Menu SRC Fall 2019 Registration Member / Guest InformationMember Name* First Last Guest Name First Last Address* Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email* Enter Email Confirm Email Phone*Emergency Contact Name Name Emergency Contact PhoneBlue Knights Chapter*(Example: GA XI or GA 11)Miles Ridden (Direct)Destination Address: 17800 US Highway 27 Pine Mountain, GA 31822Registration OptionsConference Registration - $85 per person / $160 per couple. After September 1st - $95 per person / $175 per couple.Individual - before September 1st Price: $85.00 Quantity: Couple - before September 1st Price: $160.00 Quantity: Individual - after September 1st Price: $95.00 Quantity: Couple - after September 1st Price: $175.00 Quantity: T-Shirt Purchase (No longer available)Small T-Shirt Price: $17.50 Quantity: Medium T-Shirt Price: $17.50 Quantity: Large T-Shirt Price: $17.50 Quantity: X-Large T-Shirt Price: $17.50 Quantity: XX-Large T-Shirt Price: $17.50 Quantity: XXX-Large T-Shirt Price: $17.50 Quantity: XXXX-Large T-Shirt Price: $20.00 Quantity: XXXXX-Large T-Shirt Price: $20.00 Quantity: PaymentsON-LINE REGISTRATIONS MUST BE PAID HERE ON-LINE when registering. When you click the "SUBMIT" button below you will be taken to the Paypal payment website where you will pay with a Credit/Debit Card that will be processed via Paypal.Refund PolicyRefunds will be given in accordance with guidelines set forth by Blue Knights International and the SRC pertaining to hosting of a regional conference. Member(s) who for the following reasons are unable to attend the International Convention after paying registration fees will receive a full refund: death in member’s immediate family (as denoted in the bylaws), serious illness of the member or in the member’s immediate family, accident while en-route to the convention, military call up, vacation or leave cancelled by employer. Written verification may be requested by the host chapter. Refunds requested due to other extenuated circumstances will be considered on a case by case basis.Donate to BK Special Fund (optional) Price: $1.00 Quantity: If you wish to make a donation to the Blue Knights Special Fund you may do so here in increments of $1. A donation is optional and not required.Purchase Total $0.00 Acceptance (Required)* Accept Terms & Conditions By checking the checkbox above I verify all information and that the purchase total is correct and accurately reflects the registrations and number and size of T-Shirts ordered. I have read and understand the refund policy.EmailThis field is for validation purposes and should be left unchanged.