2023 CELG Municipal Picnic

Thursday, September 7, 2023
5:30 PM
Jim Dietrich Park
4899 Stoudts Ferry Bridge Rd, Reading, PA 19605

Deadline for application: September 5th

Register:

Payment Type:
Pay now with Credit CardPay later with Invoice

First Name:	Last Name:	Email Address:
Title:	Organization:	Phone Number:
Street Address:
City:	State:	Zip Code:
Are you a municipal official, corporate sponsor of CELG, or BCW&SA member?: No ($45)Yes ($30)

Total Number of Persons Attending: 123456

Additional Registrants

Additional Attendee #1
First Name:	Last Name:	Email Address:
Title:	Organization:	Official, sponsor, member: No ($45)Yes ($30)
Additional Attendee #2
First Name:	Last Name:	Email Address:
Title:	Organization:	Official, sponsor, member: No ($45)Yes ($30)
Additional Attendee #3
First Name:	Last Name:	Email Address:
Title:	Organization:	Official, sponsor, member: No ($45)Yes ($30)
Additional Attendee #4
First Name:	Last Name:	Email Address:
Title:	Organization:	Official, sponsor, member: No ($45)Yes ($30)
Additional Attendee #5
First Name:	Last Name:	Email Address:
Title:	Organization:	Official, sponsor, member: No ($45)Yes ($30)

* In order to prevent abuse of this form, please enter the red letter
from the image below:

Submit Registration