Event Reservation Form

Lecture Series Registration

First

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Last

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Email

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Reservation Amount

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Guest Type	Number of Guests	Amount	Discount	Total
Single		15.00
Couple		25.00
Family		40.00
Sponsor		54.00
Event Sponsor		250.00
Total

Promo Code

Card Number

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Card Expiration

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Security Code

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Card Zip Code

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