Wednesday Dinner Sign-Ups

October 1, 2023

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TBA

Name *

First

Last

Email *

Phone *

Number of Adults

• 1 Adult – $ 9.00
• 2 Adults – $ 18.00
• N/A – $ 0.00

Number of Children Ages 3-12

• 1 child – $ 5.00
• 2 children – $ 10.00
• 3 children – $ 15.00
• 4 children – $ 20.00
• N/A – $ 0.00

Family Maximum ($25)

• Yes – $ 25.00
• N/A – $ 0.00

Total & Payment

Total Amount

$ 0.00

Payment Address *

Address Line 1

Address Line 2

City

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Zip Code

Payment

Card Number

MM123456789101112Expiration

/

YY2324252627282930313233

Security Code

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