Registration Information

Quantity
Price
Total
Number of Registrants

The ticket price increases to $340 on December 17, 2018

X
$
290.00=
$
0

Priest and Religious Registration

Priests and religious brothers and sisters are able to register at the discounted rate of $200.

X
$
200.00=
$
0

Final Total:
$
0

Contact Information

Name as you would like it to appear on your name tag*
Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*
Serra Club of*
District
Region
Official positions that you currently hold within Serra
U.S. Council Committee on which you are currently active or U.S. Council Committees that you would like to join
Is your spouse attending?*
  • Yes
  • No
Spouse First Name
Spouse Last Name
Spouse name as you would like it to appear on your spouse's name tag.
Official positions that your spouse currently holds within Serra
Would you like to add a guest to this registration?*
  • Yes
  • No
Guest First Name
Guest Last Name
Guest name as you would like it to appear on your guest's name tag.

Payment Information

Amount*
$
Name on Card*
Card Number*

Food allergies or special requests

Additional Comments

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