Registration Form

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Registration Form

First & Last Name *

Phone Number *

Company *

Address *

City *

Province/State *

Postal Code/Zip *

Email Address *

I would like to reserve table setting/settings ($500 each)

1 Table Setting

2 Table Settings

3 Table Settings

4 Table Settings

5 Table Settings

6 Table Settings

7 Table Settings

Clear selection

I would like to reserve table/tables with 8 settings ($4000 each)

1 Table

2 Tables

3 Tables

4 Tables

Clear selection

I would like to reserve table/tables with 10 settings ($5000 each)

1 Table

2 Tables

3 Tables

4 Tables

Clear selection

My guests will be (additional names can be noted separately) *

Payment Choices *

Credit Card. (Please fill out required information below)

Credit Card. (Calling in Credit Card Info. Please call Nancy Dunbar @ 613-720-7230)

Cheque. (Please mail cheque to Baseball Canada)

CREDIT CARD INFORMATION

Name on Credit Card

Credit Card Number

Expiry Date (MM-YY)

Card Verification Value (CVV)

The CCV is a series of three or four digits usually found on the back of the credit card.

I would like a tax receipt for my donation *

Yes

Submit

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