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To register for the 2019 PCA, Inc. Convention in Dearborn, Michigan, please fill in the form below. This form may be used to register up to two people. If you have more than two registrants, please re-submit the form, filling it in for two of them at a time. If you are just registering one person, please fill in the area labelled "Registrant No. 1".
Registrant No. 1 Name:
Name to appear on badge:
Address:
City:
State/Province:
Zip/Postal Code:
Country:		select countryUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaeroe IslandsFalkland IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIrelandIranIraqIsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint PierreSaint VincentSamoaSan MarinoSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSpainSri LankaSurinamSwazilandSwedenSwitzerlandSyriaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUS Virgin IslandsUruguayUzbekistanVanuatuVenezuelaVietnamWallis and Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZiareZimbabwe
Email address:
I will will not require an accessible parking space for my automobile.
Mobile phone number:		If you don't have a mobile phone, enter: none.
First time at a PCA, Inc. Convention?		yes no
		I volunteer to be a mentor to a first-time convention attendee. (Only check if this is not your first convention.)
PCA, Inc. Member?		yes no Note: Members pay lower convention registration fees. To become a member, click here.
Indicate which days you will be attending:		Thursday (includes Artists' Fair and Dealers' Fair on Wednesday night) Friday Saturday (includes banquet) select banquet mealDaube of BeefSalmonVegetarian      If you are attending Saturday, please select a meal choice.   I will also be attending the Wednesday (May 15) Tour of The Henry Ford ($60, PCA Inc. members only) PCA Member Thursday, Friday, Saturday $370 Thursday, Saturday $320 Friday, Saturday $320 Thursday, Friday $280 Saturday $180 Thursday $140 Friday $140 Wednesday Tour add $60 PCA Non-Member Thursday, Friday, Saturday $410 Thursday, Saturday $350 Friday, Saturday $350 Thursday, Friday $310 Saturday $195 Thursday $155 Friday $155
Registrant No. 2 Name:
Name to appear on badge:
Address:
City:
State/Province:
Zip/Postal Code:
Country:		select countryUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaeroe IslandsFalkland IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIrelandIranIraqIsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint PierreSaint VincentSamoaSan MarinoSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSpainSri LankaSurinamSwazilandSwedenSwitzerlandSyriaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUS Virgin IslandsUruguayUzbekistanVanuatuVenezuelaVietnamWallis and Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZiareZimbabwe
Email address:
Mobile phone number:		If you don't have a mobile phone, enter: none.
First time at a PCA, Inc. Convention?
		I volunteer to be a mentor to a first-time convention attendee. (Only check if this is not your first convention.)
PCA, Inc. Member?		yes no Note: Members pay lower convention registration fees. To become a member, click here.
Indicate which days you will be attending:		Thursday (includes Artists' Fair and Dealers' Fair on Wednesday night) Friday Saturday (includes banquet) select banquet mealDaube of BeefSalmonVegetarian      If you are attending Saturday, please select a meal choice.   I will also be attending the Wednesday (May 15) Tour of The Henry Ford ($60, PCA Inc. members only) PCA Member Thursday, Friday, Saturday $370 Thursday, Saturday $320 Friday, Saturday $320 Thursday, Friday $280 Saturday $180 Thursday $140 Friday $140 Wednesday Tour add $60 PCA Non-Member Thursday, Friday, Saturday $410 Thursday, Saturday $350 Friday, Saturday $350 Thursday, Friday $310 Saturday $195 Thursday $155 Friday $155
Please enter any comments. (This is the place to indicate any special requirements in compliance with the American Disabilities Act.)

2019 PCA CONVENTION COMMEMORATIVE PAPERWEIGHTS

The 2019 PCA, Inc. Convention is offering three commemorative paperweights. (See photos below.) Each one has a limited edition. You can click on any of the images below to enlarge. Feather Combed Weight With Apple Blossom by Chris Sherwin 2 7/8" diameter. Limited Edition of 30. Spotted Butterfly Over Apple Blossoms by Richard Loesel 3 3/8" diameter. Limited Edition of 20. Small Cherry Spoke Millefiori by Damon MacNaught 2 9/16" diameter. Limited Edition of 15. Chris Sherwin feather combed weight $180.00 each   qty:   0123 Richard Loesel spotted butterfly over apple blossoms $570.00 each   qty:   0123 Damon MacNaught small cherry spoke millefiori $275.00 each   qty:   0123 shipping charge — Paperweights will be shipped to the person and address you entered for registrant No. 1. US destination: $15 per paperweight international destination: $20 per paperweight

PAYMENT INFORMATION

I will pay the total membership amount using:

	PayPal — If you select this option, you will be transferred to PayPal automatically right after you submit this form.
	Credit Card — We accept Visa, MasterCard, or Discover. If you choose this option, a form will appear below, enabling you to enter your credit card information. The lock icon at the top left of your browser indicates that this is a secure page. Our website uses Secure Sockets Layering (SSL) to encrypt your personal credit card information, before it travels over the Internet.
	Check or Money Order — Please make check or money order (US dollars only) payable to PCA, Inc., and mail to PCA, Inc., Attn: Membership, PO Box 334, Fairless Hills, PA 19030-0334. When you submit this form, a printer-friendly version of your application will appear, which you can print out and send us along with your check or money order.

Cancellation and Registration Fee Refunds Policy and Procedure

Convention registration fees will be refunded under the following conditions:

• The request must be in writing.
• The request must be received or postmarked prior to the opening date of the convention.

Refunds will be made according to the following schedule:

• Refund request received thirty or more days prior to the opening date of the convention: All fees less a $40 processing fee will be refunded.

• Refund request received less than thirty days prior to the opening date of the convention: No refund.

• Refund request due to the death or serious illness of a registered member, spouse, or other family member, regardless of when the request was received: All fees less a $40 processing fee will be refunded.
  
  
• All cancellations and refund requests must be sent to the address at the bottom of this page.