Your Information:Full Name:*First NameLast NameE-mail:*Phone Number:*Area CodePhone NumberI'm reserving for:*Women's Brunch- 10:45 amDedication & dessert- 12:30Man for dedication & dessert- 12:30I would like to help sponsor this celebration:Payment Information:Total:$180.00Payment:Credit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2022202320242025202620272028202920302031Expiration YearSubmitShould be Empty: This page uses TLS encryption to keep your data secure.
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