Copy of Laurice’s Birthday Celebration

Please complete the form below to register for Laurice’s Birthday Celebration.

How many people are you registering? *

(including yourself)

Kindly fill out the information below

Donors info

First Name *

Last Name *

Email (Primary) *

RSVP and Donation

How are you coming? ($5/ person) *

Donation (optional):

Other Amount

Total for this participant

Authorize.net (Credit Card)

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

An optional donation may be added during registration.