Event Reservation Form

Lecture Series Registration

First

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Last

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Email

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Guest Type	Number of Guests	Amount	Discount	Total
Single		5.00
Couple		10.00
Sponsor		54.00
Event Sponsor		250.00
Total

Promo Code

Reservation Amount

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Donation Amount

Total Amount

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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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