The Angel of the Lord (GCBS21)

How many people are you registering? *

(including yourself)
Fill in your registration information on this page. If you are registering additional people, you will be able to enter their registration information after you complete this page and click "Review your registration".

First Participant

Email Address *

Prefix *

First Name *

Last Name *

Street Address *

City *

State *

Postal Code *

Country *

Event Fee(s)

Registration *

1st Family Member - $ 25.00

2nd Family member - $ 15.00

Each additional family member - $ 0.00

Total for this participant

Authorize.net (Credit Card)

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Name Badge

First Name *

Last Name *

City *

State *