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 Registration Form

First Name:
Last Name:
Address: City: State: Zip Code:
ID Number: Date of Birth: Month Day Year
Phone: ( ) -
Cell Phone: ( ) -
Email:
Code:  

Term and conditions:

Must be at least 21 years old to registe.

Must register on the website (chinabistronh.com) or at Baja Beach Nightclub.

By Submit the form I agree the term and conditions above.

 

  
 
Baja Beach Night Club Info. Line

(603)524-0008
 
China Bistro 89 Lake St.Laconia,NH 03246     (603)524-0008