The Freedom Center March 4th -7th, 2022
Registration & Deposit (Deposit is non-refundable)
Full Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Person, address & phone number
I acknowledge that at the hotel accommodations are double occupancy.
*
I will travel with a roommate
Please assign a roommate
I am traveling with a family of 4 or more
If you are traveling with your preferred roommate, type their full name in the box or enter NA.
*
I acknowledge the travel dates are March 4-7, 2022. *
*
Yes
Select Your Payment Plan (Monthly Payments After Deposit)
*
6 Month/ $167
4 Month / $250
One Payment $1200
Payment Options
*
Deposit $200.00 (Non-Refundable)
Total Payment $1200
Add a child age 10 to 13 $225
My Products
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Freedom Center Deposit
$
200.00
Deposit for Freedom Center
Freedom Center Total Payment
$
1,200.00
Total payment for Freedom Center
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Pay with PayPal
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
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