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Spa For the Soul online form

Spa For the Soul online form

COUNT ME IN!!!
Yes I’d like to participate 
in this years SPA FOR THE SOUL
   
I am purchasing
entrance ticket for $ (enter total amount to charge).
1 entrance fee $36* or $54 for Evening Patron, $20 for teen/tweens- Add $18 for each for each woman you are honoring. I will be honoring  Woman/en.

SPONSORS: $180 Evening Sponsor $360 Pillar

First Name*
Last Name*
Address Line 1*
Address Line 2
City*
State
Post Code*
Country
Phone
Email Address

Please charge my Credit Card

I will mail in a check for this amount. Must be received no later than May 18th.

 I'd like to pay with Paypal (check the button at the beginning of the line then CLICK HERE to be re-directed to our paypal page and THEN hit submit at the end of this form.)

Card Type
Card Number

Expiration Date(MM/YYYY)


Name On Card

 

 

CVV CODE 3-4 digit Security Code
 
I need a paper receipt. Email is not enough

 
Comments: Including Name of Person/s you will be honoring on the Table of Honor.

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