until your reservation will be released to other sign ups.
60s
Contact Information
* Please select which of the upcoming
event dates you would like to register for:
* Business Name:
* Contact Name:
* Email:
* Confirm Email:
*
Phone:
*
Gender:
Male
Female
*
Date of birth:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
*
Weight:
lb
The following Parent or Guardian information is required.
* Parent / Guardian Name:
* Parent / Guardian Email:
* Confirm Parent / Guardian Email:
* Parent / Guardian Phone:
*
Address Line 1:
Address Line 2:
*
City:
*
State:
--
*
Zip:
Additional Information
Waiver of Liability
I,
, have read the Waiver of Liability above and by checking this box and typing my full legal name, I hereby do agree to this Waiver of Liability.
Payment Information
* Refund Policy
* Payment type:
Credit Card
Credit Card Information
* Card Number:
Enter the numbers on the card only.
No dashes or spaces required.
Invalid card number
* Name On Card:
Enter the name of the cardholder
exactly as it appears on the card.
* Expiration Date:
01 - Jan
02 - Feb
03 - Mar
04 - Apr
05 - May
06 - Jun
07 - Jul
08 - Aug
09 - Sep
10 - Oct
11 - Nov
12 - Dec
* CVC:
Billing Address
Same as current address above
* Address Line 1:
* Address Line 2:
* City:
* State:
--
* Zip:
Bank Account Information
* Account Type:
Checking
Savings
* Account Number:
* ABA / Routing Number:
By clicking the "Submit" button below, I authorize the bank providing my account entered above to accept Direct Payment instructions and to debit my account or credit my account if it is necessary to make corrections. I hereby authorize Promoted Events™, and/or its authorized agents, to initiate debit entries for payment of services. I authorize adjusting credit/debits for entries made in error or entries requiring reversals. All such entries shall be made to the account indicated above.
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Submit