EmailMe Form - D2 Spring Workshop Online Registration, 2017

Name *

First Last

Club *

Email *

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Mobile Phone# *

### - ### - ####

Current Club Office/Committee

Current District Office/Committee

One Zonta subject I'd like to discuss or learn more about at this workshop is:

Please note food allergies/sensitivities

Price

$ Dollars . Cents

You will be taken to PayPal where you may select to complete your transaction via debit or credit card (Visa or M/C) Ignore the 404 page you might get after completing payment...working that out with PayPal. You will get an email, confirming your registration when it's properly completed.