Individual Registration

YOU'RE REGISTERING A COUPLE or ONLY YOURSELF FOR: Lost Dutchman Widders Ball 2026
Register Couple or Only Yourself.

Couple or Stag *

First Name *

Last Name *

Widder's Name

Email *

Your Home Chapter *

Address *

City *

State *

Zip *

Country *

Liability Waiver *

Liability Waiver By checking this box, I acknowledge that I have read and understand the terms of this liability waiver and agree to assume all risks associated with participating in this activity.

Payment Information

Amount

Payment Method

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*