To register for adult programs or special events, complete and
submit this secure form with payment information. Registrations
should be received no later than 3 days prior to the event date.
After this day, registrations should be confirmed by calling
401-253-2707 ext. 21.
Refund and Cancellation Policy: Blithewold cannot refund
programs in the event of a cancellation. In the unlikely event
that this program is cancelled or postponed due to insufficient
enrollments or unforeseen circumstances, Blithewold will fully
refund registration fees.
Please complete a separate form for each paying participant. All
fields marked with a red star are mandatory and must be
completed to ensure a successful registration.
If you would rather print out a form and mail it with payment,
please click here .
You may also register via phone, Monday - Friday, 9:00 - 5:00,
by calling 401-253-2707 ext. 21.
My Information
I am a:
Member
Non-Member
Fist Name:
*
Last Name:
*
Address:
*
City:
*
State:
---
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
Zip:
*
E-mail:
*
Day Phone:
* ex.
(123)-123-4567
Fax:
ex. (123)-123-4567
Evening Phone:
* T ype
"same" if same as day phone
Special
Events
<%
rs.open "select * from events where event_category_id=1",con,1,1
if rs.recordcount>0 then
do while rs.eof=false
memberPrice=rs("member_price")
nonMemberPrice=rs("non_member_price")
childPrice=rs("child_price")
%>
Name:
<%=rs("name")%>
Date:
<%=rs("event_month")%> <%=rs("event_day")%>, <%=rs("event_year")%>
Start Time:
<%=rs("start_time")%>
End Time:
<%=rs("end_time")%>
Description:
<%=rs("description")%>
Purchase:
<%
rs.movenext
loop
end if
rs.close
set rs=nothing
%>
Programs
<%
set rs=server.createobject("adodb.recordset")
rs.open "select * from events where event_category_id=2",con,1,1
if rs.recordcount>0 then
do while rs.eof=false
memberPrice1=rs("member_price")
nonMemberPrice1=rs("non_member_price")
childPrice1=rs("child_price")
%>
Name:
<%=rs("name")%>
Date:
<%=rs("event_month")%> <%=rs("event_day")%>, <%=rs("event_year")%>
Start Time:
<%=rs("start_time")%>
End Time:
<%=rs("end_time")%>
Description:
<%=rs("description")%>
Purchase:
<%
rs.movenext
loop
end if
rs.close
set rs=nothing
%>
Billing Information
Order Total:
Credit Card Type:
Visa
MasterCard
*
Credit Card Number:
* (no spaces or
dashes)
Expiration Date:
---
01
02
03
04
05
06
07
08
09
10
11
12
-----
2006
2007
2008
2009
2010
2011
2012
*
Verification
Code:
*
The last 3 or 4 digits on the back of your
credit card