If this is your first journey with us, please complete the form entirely or it may not be accepted. If you attended any event in the past, just provide the basics.

I am registering:               Single Couple

Scene Name:                  

Email:                               

Confirm Email:               

Full Legal Name:            

Street Address:               

City:                                   

State:                                

Zip Code:                         

Phone (Optional):           

Please enter same information for additional persons attending.

Are there any special needs or accommodations that we need to be aware of?

Cost is a mere $40 per person.

I want a cool T shirt, too.            

Small      Medium     Large      X Large  - $20 each

XX Large     XXX Large - $24 each

Want more than one shirt? Tell us below.

 

Do the math and send payment through paypal.

If you are sending a check it MUST be received no later than May 21st or your spot will be forfeited.

PowerExchange Productions
P.O. Box 5822
Bloomington, IL 61702

E-mail us: Leatherpalooza@aol.com

PayPal - enter Leatherpalooza