Please enable JavaScript in your browser to complete this form.LayoutName: *Date: *Teen/AdultTeen (13+)AdultTeen AgeAddress: *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLayoutPhone:Email: *Church affiliation if applicable:VIP Table $300 seats 5 guest (please list all names and select individual cost)YesNoLayoutVIP Guest 1. LayoutVIP Guest 2. Layout VIP Guest 3. LayoutVIP Guest 4. LayoutVIP Guest 5. Register with other women (please list all names in group)YesNoLayoutGroup Guest 1.LayoutGroup Guest 2.LayoutGroup Guest 3.LayoutGroup Guest 4. LayoutGroup Guest 5. LayoutGroup Guest 6. Please check your registration:Registration (Deadline: September 8, 2024) – $ 60.00Sponsor another woman – $ 60.00VIP Table (List all 5 names above) – $ 300.00Sponsor another woman: Name Donations1 – $ 10.002 – $ 20.003 – $ 30.004 – $ 40.005 – $ 50.00Other – $ 0.00Donation Amount OtherLate Registration: Unfortunately, due to high demand, we will not have late registration or same day purchase on the day of the event. Please register before the scheduled cutoff date and secure your seat by registering by September 8, 2024 while seats are available. Purchase your VIP table now before they sale out. Doors open at 11:15 a.m. and the event will start promptly at 12:00 p.m. Non-Refundable clause: (Please check box)I hereby certify the following: The cost of registration is final and there will be no refund given however I may transfer my ticket to another woman. Your electronic signature states that you are aware and agree on the terms and conditions above.Non-Refundable clause signature: *Clear SignatureParent/Guardian Signature, if under age 18: Emergency Contact Name: *Emergency Contact Phone: *Emergency Contact Relationship: *Parent/Guardian Signature, if under age 18: Under Age 18 Signature:Clear SignatureTotal$ 0.00PayPal Commerce *PayPal CheckoutCredit CardCard NumberExpiration DateSecurity CodeCard Holder NameSubmit Registration
