Event Registration MICDS 2022 Spring Break Dinner & Tee Payments Private Dinner (March 12) Quantity Price: $75.00 Quantity * Price is per personNames of those attending dinner on the 12th Private Dinner (March 15) Quantity Price: $75.00 Quantity * Price is per personNames of those attending dinner on the 15th Graduating Senior Tee Shirt Quantity* Price: $30.00 Quantity Names of those you are getting tees Total $0.00 Your InformationName* First Last Phone*Email* Enter Email Confirm Email Credit Card InformationName on Credit Card* Card type*ChooseMaster CardVisaAmerican ExpressDiscoverCard Number* Expiration* Card Verification Code/CVV* Billing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Agreement & Cardholder SignatureCardholder Signature*To complete the authorization to charge your credit card for the total above, you must type your name in the field below. This will serve as your electronic signature - the equivalent to signing your name on a printed credit card authorization slip. HiddenNew Payment Standard Service Fee HiddenBranchHiddenSite HiddenAgent Traveloni Foremost WCT Oswego HiddenProfile Type Leisure Corporate HiddenClient Status Foremost Travel Traveloni WCT Oswego HiddenSync Form Type Payment HiddenCountry HiddenPayment Type Credit Card CommentsThis field is for validation purposes and should be left unchanged. Δ
