Registration Form Las Vegas 2023

If you are paying by check, you may use the form below to submit your registration information, and send your check separately by mail to the address provided at the bottom of the form. Please note: The registration fee in NON-REFUNDABLE unless the event is cancelled by Crones Counsel.

If you plan to pay by credit or debit card online, please fill in the additional credit card payment fields below, and submit. You may enter your personal information with confidence, as we use SSL encrypted security for our registration form and shopping cart.

Your registration details * Indicates a required field

    Your First Name *

    Your Last Name *

    Email *

    Address *

    City *

    State *

    Zip *

    Telephone *

    Birth year *

    Is this your first time?


    How did you hear about Crones Counsel?

    Your emergency contact's name *

    Your emergency contact's phone number *

    Preferred Payment Method:


    I have read and accepted the Liability Waiver* (opens in new window)


    Please make checks payable to: CRONES COUNSEL, INC.

    Mail checks to:
    Crones Counsel
    c/o Kay Marie Bouma
    5452 Hillery Drive
    Scottsdale, AZ 85254

    Phone: 602-377-5632