Infusion 2011 Group Registration ($40/person)

Description: Group registration for the Infusion 2011 event at $40/person. MINIMUM OF 5 ATTENDEES REQUIRED FOR GROUP STATUS.
Quantity:1
Price: $40 per person
TOTAL DUE: 40

REGISTRANT INFORMATION

Full Name:
Street Address:
City:
State:
Zip Code:
Country:
Phone:
Valid Email:
Your Relationship to Nyack/ATS:
Other?

COMMENTS/ADDITIONAL INFORMATION

REQUIRED: Please provide the full name (required) and church or group affiliation (optional) for EACH PERSON in your group.

BILLING INFORMATION

Amount Due: $40 USD
 
Card Number:
CID Number:
(numbers only, format MMYYYY, i.e. '042019')
Card Exp. Date:
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