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Upcoming Events Fire on Ice

Fire on Ice Registration Form

About You:
Full Name*
First Name Last Name
Phone Number*

Area Code Phone Number
E-mail*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Number of people you are registering for - Adults:*
Names of Adult Participants:
Number of people you are registering for - Children:
Names of Child Participants:
How did you hear about this event?
Comments:
I would be interested in joining a Fire on Ice committee to help prepare in advance for this event
I'm interested to volunteer at the Fire on Ice Event Sunday Dec 29th
Optional donation:
YES! I would like to partner in bringing this program to our community

$36$72$180$360$540$1000$1800

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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