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A TEST Event
How many people are you registering?
*
1
2
3
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10
Fill in your registration information on this page. You will be able to enter the registration information for additional people after you complete this page and click "Continue".
Your Registration Info
First Name
*
Last Name
*
Email Address
*
Event Fee(s)
Event Fee(s)
*
Adults
–
$ 100.00
Children
–
$ 40.00
Adults -Non member price
–
$ 100.00
Child- Non Member price
–
$ 40.00
Total for this participant
Payment Options
Payment Method
EWay Payment Processor for CiviCRM use
I will send payment by check
Billing Name and Address
Billing First Name
*
Billing Middle Name
Billing Last Name
*
Street Address
*
City
*
Country
*
- select -
Australia
Israel
United States
United Kingdom
State/Province
*
- select State/Province -
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Postal Code
*
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