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THE FIFTH ANNUAL LONE START SPANKING PARTY
Southern Belles and Gents
Dates: May 16-20, 2019

Cost:
$150 Single Male w/Sat night meal
$125 Single Female w/Sat night meal
$250 Couple w/Sat night meal
$100 Single Male
$85 Single Female
$175 Couple
$75 Saturday Only
$100 Vendor Not Attending Party
$50 Vendor Attending Party
$10 Each Extra Vendor Table

If you are a couple please fill out two applications – one for each of you.

Print this registration form and mail it with a check or money order made out to LSSP:

Send completed form and payment to:

Sarah Gregory
PO Box 616
Broad Brook, CT, 06016

Name (Last, First) _________________________________________

Please provide a dependable email address (Make SURE this is right.
Your party information will be sent this way)

_____________________________________________________

_____________________________________________________

Emergency contact name: ____________________________________

Emergency contact phone: __________________________________________

Scene Name (for name tag)
___________________________________________________________________

FetLife Handle (if different from Scene Name)
___________________________________________________________________

Circle one: Top / Bottom / Switch / Observer

Circle one: Male / Female / Other

Birthdate: ______________________

Check any that apply:
_____ I am a vendor and would like to be part of the vendor fair.
_____ I am a single lady and would like to stay in one of the “roommate assistance” rooms.
_____ I am new and would like a “mentor.”

ALL OF THE ABOVE INFORMATION, WITH THE EXCEPTION OF THE INFORMATION ON YOUR NAME
TAG, WILL BE KEPT STRICTLY CONFIDENTIAL. IF YOU ARE A MARRIED COUPLE, YOU MAY USE
YOU SPOUSE AS YOUR EMERGENCY CONTACT, IF HE/SHE WILL BE AT THE PARTY ANYWAY.

My signature below certifies that I have read the party rules and agree to abide by them.
I will hold the Lone Star Party organizers harmless for any injuries or accidents to my person,
regardless of the cause of same, including, but not limited to any injury or accident caused
solely by the negligence of the organizers. I will hold the organizers harmless for any lost
or stolen items of personal property that belong to me. I will be responsible for any accidents,
injuries, or damages to any persons or property caused by myself or my actions. I certify that I
will not be under the influence of any illicit or mind-altering drugs at the party.

______________________________________________________ ____________
Signature Date