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
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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