METHOD OF PAYMENT

Event Payment Form

Event:      

Membership:       Parades      Den Party      Balcony Party       Epiphany:   

Miscellaneous: (Description)  

Name On Card:

Phone:  

 Work Email Address:  

 Personal Email Address:  

Current address:

City:

State:

ZIP Code:

Amount of Purchase:

I agree to pay the above total

Signature of Buyer:

Date: