Reservation December 12, 2024 (Perrysburg, OH)By Chandler Holder / December 12, 2024 September 6, 2024 Date/Time Date(s) - 12/12/2024 - 12/15/20244:00 pm - 5:00 pm Location Quality Inn Perrysburg, OH 6/18/23 Bookings Event Details Date(s) 12/12/2024 - 12/15/2024 04:00 pm - 05:00 pm Locations December 12, 2024 (Perrysburg, OH) Tickets Ticket Type Price Spaces Shared Room $520.00 0 1 2 3 4 5 6 7 8 9 10 11 Single Room $665.00 0 1 2 3 4 5 6 7 8 9 10 11 Registration Information Attendee First Name * Attendee Last Name * Email * If you do not have an email address, please enter info@efebh.org Age * Date of Birth * Sex * female male Last Four Digits of Social Security Number * Address * City/Town * State * Zip/Post Code * Phone * Medications Special Diet Needs Known Allergies/Food Reactions Special Medical Needs If Yes, When and Where? Pregnancy Status * I am pregnant I am not pregnant Are you a smoker? yes no Prior Drug And Alcohol Treatment? yes no EMERGENCY CONTACT INFORMATION Contact Name * Contact Phone * Relationship * PERSONAL INFO Ordering Court * Ordering Court ... Toledo Bowling Green Findlay Fremont Maumee Sylvania Oregon Ottawa Perrysburg Putnam County Sandusky #1 Sandusky #2 Other (not listed) Other Court (if not listed above) Case/Reference # * Blood Alcohol Content Drivers License Number * Issuing State * If you have an Ohio License: Is your License Suspended? * Yes No N/A Number of Points on License PAYMENT INFO !! PLEASE hit book now only ONCE to avoid MULTIPLE CHARGES. If you recieve an error message, Please STOP and call our office 567-315-1710 !! First Name * Last Name * Billing Address * Zip Code * Phone Number * How do you want to make a payment * Credit Card Mail a check Choose Payment * Full Pay $175 Deposit Only You will receive an email confirming your registration. Please check your JUNK mailbox as it may go there. Country * Payment method confirmation You are only paying the deposit and the full amount need to be paid 1 week before event to keep the spot. I consent to my submitted data being collected and stored as outlined by the site .