You
have
reached the WIL secure payments page for EVENTS REGISTRATION. Complete the
form below to submit your payment.Your receipt will be
sent to the email address
you provide.
STARRED ITEMS (*) ARE REQUIRED FOR REPORTING TO THE STATE OF CALIFORNIA.
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WIL
LUNCHEON/SPECIAL EVENT REGISTRATION FORM
Please complete one form to pay for up to 5 attendees.
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| Date/Description*: |
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| First
Name*: |
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| Last
Name*: |
YOU MUST USE YOUR CREDIT CARD BILLING ADDRESS.
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| Address*:
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| City*:
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| State*:
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| ZIP*:
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| Occupation*:
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| Employer*:
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Home
Phone:
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Email*:
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| Vegetarian Option:
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| Level*:
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Members, please use the down arrow on the right to select your membership level, which determines your charge for the lunch.
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ABOUT MY GUESTS: |
| Guest 2*:
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| Guest 3*:
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| Guest 4*:
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| Guest 5*:
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If amount due, enter credit card and expiration date below: |
Credit
Card
Number: |
(No
spaces/dashes) Visa/MC/AMEX accepted.
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Expiration
Date:
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(MMYY) NO dashes or slashes. For example "0916" for September, 2016. |
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Upon submission, your card will be charged if any amount is due. Your name will be added to the RSVP list, and if a charge was required, a receipt will be sent via email to the address you provided on this form.
By clicking the button below, you confirm reading these instructions.
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Copyright 2010 Women
in Leadership. | Payments processed by authorize.net.
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