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Louisiana Good Sam

Confirmation of Payment & Pre-Registration Form


Thank you for your payment. Your transaction has been completed, and a receipt for your purchase has been emailed to you. You may log into your account at www.paypal.com/us to view details of this transaction.

You must now complete the pre-registration form below. You can only use this form after completing your Paypal payment unless you are registering as a comp attendee and not required to pay any fees. If you have a problem completing the form you must contact the webmaster from the home page 'Webmaster' link or through the 'Contact' webpage.

If you have reached this page and have not paid your fees through Paypal, STOP and click here! You registration WILL NOT be accepted unless you have paid your fees through PayPal.

Questions with a * red asterisk are absolutely required!

*  Have you read and do you understand the online registering requirements?

Yes No (If NO, please stop and re-read the instructions)

Choose the  Louisiana Samboree you are registering for:

Fall
Spring

Please enter your anticipated arrival day: This is just to give us a daily estimate.

Please provide the following contact information:

*Last Name
*First Name(s) His & Hers
*Chapter # & Name
Enter 'At Large' if you do
 not belong to a chapter
 
*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
*Home Phone
*E-mail
*Re-Enter E-mail
Do they match?

Please enter your Good Sam ID number and expiration date:

Is this your first Samboree?

Yes No

Is this your first Louisiana Samboree?

Yes No

Enter children's names & ages in the space provided below. (No charge under 18).

Choose the registration type that you paid for with PayPal:

Rig/2 Persons
Rig/1 Person
State Staff , Host Chapter, or other comp
Vendor or other non-site lodging registration

Please indicate below the number of extra fees that you paid for with PayPal:

QTY Items offered at this event

Total Amount Paid: DO NOT enter a $, enter the amount only. exmpl: 48.00

Enter one of the following registration codes:
Regular Paypal registrant = "Paypal"
  :  State Staff ="Staff"  :  Host Chapter ="Host"  :  Out Of State Comp Staff ="OS + (your title & state)" :
Other Comp = "Comp + (reason)"  :  Vendors NOT lodging at campground or required to pay a fee = "Vendor"

I/WE understand the Louisiana Good Sam Organization has taken reasonable and necessary precautions and, therefore, I/WE accept full responsibility for the welfare of my/our unit and all persons in my/our unit while attending this Louisiana Samboree.

The Louisiana Good Sam Organization reserves the right to refuse registration and/or admittance to anyone.

If you agree with all of  the above terms and conditions of your registration and attendance
 type 'yes' or 'no' (in lowercase only) in the box below.

Did you find registering online easy?

Yes No

What would you suggest we change or add to make this type of registration easier?

BEFORE YOU HIT THE 'SUBMIT' BUTTON, PLEASE RECHECK YOUR FORM AND MAKE SURE THAT YOU HAVE COMPLETELY FILLED IN THE FORM !


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Copyright 2004 Louisiana Good Sam. All rights reserved.
Revised: December 04, 2005