EmailMe Form - 2020 CENTENNIAL CELEBRATION

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WELCOME TO THE 2020 CENTENNIAL REGISTRATION, PLEASE READ THE FOLLOWING:

BE ADVISED, THE CENTENNIAL REGISTRATION IS THE ONLY REGISTRATION FOR 2020, THERE IS NO SPECIFIC REGISTRATION FOR THE PCEJ WORKERS' MEETING OR HOLY CONVOCATION. DELEGATE BENEFITS ARE HIGHLIGHTED BELOW.

IF YOU WANT TO BECOME A 2020 CENTENNIAL DELEGATE, PLEASE CONTINUE AND COMPLETE THE REQUIRED FIELDS.

ONCE YOU HAVE COMPLETED CHECKOUT AND PAYMENT, PLEASE KEEP YOUR CONFIRMATION AS YOU WILL NEED IT IN THE FUTURE.

THANK YOU FOR YOUR SUPPORT! *
I HAVE READ AND FULLY UNDERSTAND THE INSTRUCTIONS
Name *
First Last
Preferred Phone # *
### - ### - ####
Address *

Street Address City State / Province / Region Postal / Zip Code
Email *
CENTENNIAL REGISTRATION:

PLEASE NOTE: REGISTRATION IS PER PERSON FOR A LEGACY LEGACY LEAF. *
1 PERSON - $100
2 PERSONS - $200
3 PERSONS - $300
4 PERSONS - $400
*Processing fees will be added at checkout. Processing fees are non-refundable.

PAYMENT INSTRUCTIONS:
- SELECT PAYMENT AMOUNT
- PLACE DELEGATE(S) NAME IN THE BOX BELOW
List the name(s) of the delegates including yourself *
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*HONOR A DECEASED LOVED ONE ON THE PCEJ VIRTUAL LEGACY TREE*
Would you like to purchase additional Legacy Leaves? *
Yes, I would like to purchase additional Virtual Legacy Leaves.
No, I do not wish to purchase additional Virtual Legacy Leaves at this time.
If Yes, select amount, place the Honoree(s) name in the suggested box.
CENTENNIAL VIRTUAL LEGACY LEAF OPTIONS:
*Please place "In Memory Of" below if your honoree is deceased
List the name(s) of the Legacy Honoree:
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PLEASE NOTE, a Paypal Account is not necessary to checkout. To submit a payment, please proceed as a Paypal guest. *
I HAVE READ AND FULLY UNDERSTAND THE INSTRUCTIONS