SPCS

Texas Diwali Event Registration 2018

Registration Form

First Name*

Last Name*

Chapter *

Email*

Phone(C)*

Phone(H)

State*

City*

Zip Code*

Address*

Please do not hesitate to contact us with questions or concerns.

Age Group	Rate
Kids (Ages under 10 year)	Free
Adults (Life Member)(10 years and above)	$20.00
Adults (Non Life Member)(10 years and above)	$30.00
Adults (Life Member and Non Life Member Both)(10 years and above)(after deadline Date : 10th November 2018)	$30.00

Choose Sponsorship/Donation Level

Enter Amount ($)

Free Ticket (check for free ticket if you are applicable for that)

Pay Full Ticket Amount ($40)

Full Name*	Relationship*	Age Group	Gender*	Food Type	Fees($)	#

Total Amount ($)

Payment Type:-

By Credit Card/ Debit Card/ Paypal

By Check & Cash

Payment Received($): 0

Total Fees($) Convenience Fees (2.9% + $0.30) :