Registration Form

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

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

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