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Fundraiser Registration Form- Credit Card Payment


Use this form to complete registration for The Siena School Scholarship Fundraiser: Denim and Diamonds on April 28th.
If attending please complete the attendee registration below, if giving a donation for a teacher ticket, but you are not actually attending the event personally, skip down to #2 Payment.
Attendee #1
Attendee #2
Guest Name (optional)
Contact me for additional guest names.
Email address
 
Payment- credit card information

#2. Name on Card
Billing Address
City
State
Zip Code
Card Number
Card Type
CVV Code
Expiration Month
Expiration Year (last two digits 2018 would be 18)
Select from the options below:
*If registering a couple- enter a 1 in the box for both people. Should read 1@$129
If registering a second couple and paying for them (ex. grandparents) enter 2@$129
Individual  @ $77.00
Couple  @ $129.00
Sponsor a Faculty Member's Attendance  @ $51.00
Introduce a Friend to The Siena School  @ $51.00
I'd like to help fund a scholar by contributing towards the goal of $41,205:
Fund a Scholar in the amount of:
Form Total: $0.00


 


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