I'm Hooked Inc. - Youth Fishing Event Registration

1
Your Name* This field is required.
First Name
Last Name
Suffix
2
Email* This field is required.
example@example.com
3
Your Emergency Phone Number* This field is required.How can you be reached during the day of the event.
Area Code
Phone Number
4
Which I'm Hooked Fishing Event Are Registering For?
5
Which Hagg Lake Event Day Are You Registering For?* This field is required.
2019 I'm Hooked: Youth & Family Fishing Event Day 1, June 1st @ Hagg Lake, Gaston, OR.
2019 I'm Hooked: Youth & Family Fishing Event Day 2, June 2nd @ Hagg Lake, Gaston, OR.
6
Please register ALL members of your party below with the details below. Lunches for the kids are always free.
First Name
Last Name
Age
Shirt Size
First Family Member
Second Family Member
Third Family Member
Fourth Family Member
Fifth Family Member
Sixth Family Member
Seventh Family Member
Eighth Familiy Member
First Family Member
Second Family Member
Third Family Member
Fourth Family Member
Fifth Family Member
Sixth Family Member
Seventh Family Member
Eighth Familiy Member
First Name
Last Name
Age
Shirt Size
First Name
Last Name
Age
Shirt Size
First Name
Last Name
Age
Shirt Size
First Name
Last Name
Age
Shirt Size
First Name
Last Name
Age
Shirt Size
First Name
Last Name
Age
Shirt Size
First Name
Last Name
Age
Shirt Size
First Name
Last Name
Age
Shirt Size
1 of 8
7
Age of the Youth you are registering?
8
What Size FREE Youth Event T-Shirt Do You Need?
Small
Medium
Large
X-Large
9
Will you take a moment to complete our survey and keep our programs free in the future?This information is requested by our foundation partners to continue their support of I'm Hooked, Inc..
YESNO
10
EthnicitySelect more than one if needed.
African American
Asian American
Euro American
Indian American
Latin American
Native American
Pacific Islander
Foreign Guest Worker
11
Zip CodePlease provide us with your zip code so we can learn more about the youth we serve.
12
Which State Are You From?Please select from the drop-down list below
Washington
Oregon
California
13
Which California County Are You From?Please select your county from the drop-down list below.
Alameda
Alpine
Amador
Butte
Calaveras
Colusa
Contra Costa
Del Norte
El Dorado
Fresno
Glenn
Humboldt
Imperial
Inyo
Kern
Kings
Lake
Lassen
Los Angeles
Madera
Marin
Mariposa
Mendocino
Merced
Modoc
Mono
Monterey
Napa
Nevada
Orange
Placer
Plumas
Riverside
Sacramento
San Benito
San Bernardino
San Diego
San Francisco
San Joaquin
San Luis Obispo
San Mateo
Santa Barbara
Santa Clara
Santa Cruz
Shasta
Sierra
Siskiyou
Solano
Sonoma
Stanislaus
Sutter
Tehama
Trinity
Tulare
Tuolumne
Ventura
Yolo
Yuba
14
Which Oregon County Are You From?Please select your county from the drop-down list below.
Baker
Benton
Clackamas
Clatsop
Columbia
Coos
Crook
Curry
Deschutes
Douglas
Gilliam
Grant
Harney
Hood River
Jackson
Jefferson
Josephine
Klamath
Lake
Lane
Lincoln
Linn
Malheur
Marion
Morrow
Multnomah
Polk
Sherman
Tillamook
Umatilla
Union
Wallowa
Wasco
Washington
Wheeler
Yamhill
15
Which Washington County Are Your FromPlease select your county from the drop-down list below.
Adams
Asotin
Benton
Chelan
Clallam
Clark
Columbia
Cowlitz
Douglas
Ferry
Franklin
Garfield
Grant
Grays Harbor
Island
Jefferson
King
Kitsap
Kittitas
Klickitat
Lewis
Lincoln
Mason
Okanogan
Pacific
Pend Oreille
Pierce
San Juan
Skagit
Skamania
Snohomish
Spokane
Stevens
Thurston
Wahkiakum
Walla Walla
Whatcom
Whitman
Yakima
16
Which Community Are You From?
Adair Village
Adams
Adrian
Albany
Aloha
Altamont
Amity
Antelope
Arlington
Ashland
Astoria
Athena
Aumsville
Aurora
Baker City
Bandon
Banks
Barlow
Barview
Bay City
Beaver
Beaverton
Bend
Biggs Junction
Boardman
Bonanza
Brookings
Brooks
Brownsville
Bunker Hill
Burns
Butte Falls
Butteville
Canby
Cannon Beach
Canyon City
Canyonville
Cape Meares
Carlton
Cascade Locks
Cave Junction
Cayuse
Cedar Hills
Cedar Mill
Central Point
Chenoweth
Chiloquin
City of The Dalles
Clackamas
Clatskanie
Cloverdale
Coburg
Columbia City
Condon
Coos Bay
Coquille
Cornelius
Corvallis
Cottage Grove
Cove
Creswell
Culver
Dallas
Dayton
Dayville
Depoe Bay
Deschutes River Woods
Detroit
Donald
Drain
Dufur
Dundee
Dunes City
Durham
Eagle Point
Echo
Elgin
Elkton
Enterprise
Eola
Estacada
Eugene
Fairview
Falls City
Florence
Forest Grove
Fossil
Four Corners
Garden Home-Whitford
Garibaldi
Gaston
Gates
Gearhart
Gervais
Gladstone
Glendale
Glide
Gold Beach
Gold Hill
Gopher Flats
Grand Ronde
Granite
Grants Pass
Grass Valley
Green
Greenhorn
Gresham
Haines
Halfway
Halsey
Happy Valley
Harbeck-Fruitdale
Harbor
Harrisburg
Hayesville
Hebo
Helix
Heppner
Hermiston
Hillsboro
Hines
Hood River
Hubbard
Huntington
Idanha
Imbler
Independence
Ione
Irrigon
Island City
Jacksonville
Jefferson
Jennings Lodge
John Day
Johnson City
Jordan Valley
Joseph
Junction City
Keizer
King City
Kirkpatrick
Klamath Falls
Labish Village
Lafayette
La Grande
Lake Oswego
Lakeside
Lakeview
La Pine
Lebanon
Lexington
Lincoln Beach
Lincoln City
Lonerock
Long Creek
Lostine
Lowell
Lyons
McMinnville
Madras
Malin
Manzanita
Marion
Maupin
Maywood Park
Medford
Mehama
Merrill
Metolius
Metzger
Mill City
Millersburg
Milton-Freewater
Milwaukie
Mission
Mitchell
Molalla
Monmouth
Monroe
Monument
Moro
Mosier
Mount Angel
Mount Hood Village
Mount Vernon
Myrtle Creek
Myrtle Point
Nehalem
Neskowin
Netarts
Newberg
Newport
North Bend
North Plains
North Powder
Nyssa
Oak Grove
Oak Hills
Oakland
Oakridge
Oatfield
Oceanside
Odell
Ontario
Oregon City
Pacific City
Paisley
Parkdale
Pendleton
Philomath
Phoenix
Pilot Rock
Pine Grove
Pine Hollow
Portland
Port Orford
Powers
Prairie City
Prescott
Prineville
Rainier
Raleigh Hills
Redmond
Redwood
Reedsport
Richland
Rickreall
Riddle
Rivergrove
Riverside
Rockaway Beach
Rockcreek
Rogue River
Roseburg
Roseburg North
Rose Lodge
Rowena
Rufus
St. Helens
St. Paul
Salem
Sandy
Scappoose
Scio
Scotts Mills
Seaside
Seneca
Shady Cove
Shaniko
Sheridan
Sherwood
Siletz
Silverton
Sisters
Sodaville
South Lebanon
Spray
Springfield
Stanfield
Stayton
Sublimity
Summerville
Sumpter
Sunnyside
Sutherlin
Sweet Home
Talent
Tangent
Terrebonne
Three Rivers
Tigard
Tillamook
Toledo
Tri-City
Troutdale
Tualatin
Turner
Tutuilla
Tygh Valley
Ukiah
Umatilla
Union
Unity
Vale
Veneta
Vernonia
Waldport
Wallowa
Wamic
Warm Springs
Warrenton
Wasco
Waterloo
Westfir
West Haven-Sylvan
West Linn
Weston
West Slope
Wheeler
White City
Willamina
Wilsonville
Winchester Bay
Winston
Woodburn
Wood Village
Yachats
Yamhill
Yoncalla
17
What Attracted You to Our Event?Please select more than one if needed.
Price
Location
Primary Activity
Secondary Activities
Special Interest
Being Outdoors
Engaging with Family Members
18
Address* This field is required.We would like to collect this information for liability reasons.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
19
Would you like to be included on our mailing list?* This field is required.
YES - Definitely!
No - Not going to bite today
20
Additional Event Fees For Adult Wishing to Enhance Their ExperienceThese optional fees cover adult lunches (kids are always free) , and event t-shirts for adults.
prevnext( X )
My Bag
1
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costUSD
I'm Hooked Youth Fishing Day Adult Lunch Tickets
$5.00+Edit
Back
0
0
1
2
3
4
5
6
7
8
9
10
Quantity
Subtotal: $0.00
I'm Hooked Youth Fishing Day ADULT T-Shirt
+Edit
Back
T-Shirt Quantity Price
XS
0
1
2
3
4
$5.00
S
0
1
2
3
4
$5.00
M
0
1
2
3
4
$5.00
L
0
1
2
3
4
$5.00
XL
0
1
2
3
4
$5.00
XXL
0
1
2
3
4
$6.00
XXXL
0
1
2
3
4
$6.00
XXXXL
0
1
2
3
4
$6.00
Subtotal: $0.00
Total cost $0.00
21
How to use PayPal to make your payment.

When you hit the submit button you will be taken to PayPal's payment gateway. If you do not have a PayPal account - don't worry. Look at the bottom of the form (in the example below we have circled it in yellow) and you will see a button that will allow you to pay by debit or credit card.

Why We Use PayPal

We use PayPal because it is the most secure and least expensive form of payment available to I'm Hooked. This way more dollars go to the kids!
22
23
Tags
Todo
In Progress
Done
Should be Empty:

T-Shirt	Quantity	Price
XS	0 1 2 3 4	$5.00
S	0 1 2 3 4	$5.00
M	0 1 2 3 4	$5.00
L	0 1 2 3 4	$5.00
XL	0 1 2 3 4	$5.00
XXL	0 1 2 3 4	$6.00
XXXL	0 1 2 3 4	$6.00
XXXXL	0 1 2 3 4	$6.00