Check Registration Form

Don’t forget to
PRE ORDER YOUR 2024 T-SHIRT!
Confluence T-shirts are not guaranteed unless you pre-order. 

Use this form ONLY if you are purchasing your membership by check.
Complete this form before June 30th and click [SUBMIT] then mail your check to:

Confluence Membership
PO Box 79281
Pittsburgh, PA 15216

Registrations through this form after June 30th will not be honored!

• Make sure a name on the check matches at least one name that you are purchasing the memberships for so we can allocate the check to the correct membership.
• If you are purchasing a membership for someone not listed on your check, please include a note with your check and list the names of the people the memberships are for.
• Please be aware that your name may not be added to the Registered Members page until after we process your check payment. This may take up to a month.

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Please indicate you understand that this is a CHECK ONLY registration form.

• Yes

Legal Name *

First

Last

Badge name(s) if different from legal name.

Address

Address Line 1

Address Line 2

City

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Zip Code

Phone

Email *

Name(s) and information for additional registrations that will be part of your check payment:

Please include the memberships you are registering for. For example: Adult membership + Full Weekend + Price. Or Child membership, Saturday only + Price

I have read and agree to the Confluence Refund Policy

• Yes

Refund Policy

I have read and agree to the Confluence Code of Conduct *

• Yes

Code of Conduct

Help us save postage & paper. We are switching to emailed Confluence reminders through our newsletter. If you need a paper flyer for next year, check the box and we will mail you one. Mail me a paper flyer.

• Yes

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