Register for the March

Please fill out this form to register for Rose Dinner with Alveda King.

First Name *

Last Name *

Address

Address 2

City

Postal Code

Province

Country

Phone *

Email *

Payment Information

Amount

CAD

Payment Method *

PayPal account or credit card E-Transfer

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Holder Name*

Captcha*

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