Our Lady of Lourdes

Melbourne, FL

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Trivia Night Registration Form

- Supporting OLL

Please complete and submit
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- Team Name Please enter valid data.
- E-Mail Address REQUIRED Please fill out this field. Please enter valid data.
- Team Captain Please enter valid data.
- Names of Players:
- Team or Donation Information (Choose One) REQUIRED Team Table Registration - $200 Team Table Registration AFTER January 24th - $250 Individual Registration - $25 Individual Registration AFTER January 24th - $30 Unable to attend, but please accept my donation (donations of $100 or more, name will appear on Sponsor Board) Please fill out this field.
- Payment Information REQUIRED Credit Card Check (to be mailed or delivered to School Office - Must be receive by January 29th) Cash (to be mailed or delivered to School Office - Must be receive by January 29th) Please fill out this field.
- Name on Card Please enter valid data.
- Credit Card Number (Visa/MC/AMX) Please enter valid data.
- Expiration Date Please enter valid data.
- CVI Code Please enter valid data.
- Billing Street Address Please enter valid data.
- Billing City Please enter valid data.
- Billing State Please enter valid data.
- Billing Zip Code Please enter valid data.
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