Aleph Champ Meetup

How many people are you registering? *

(including yourself)

First Name *

Last Name *

Street Address *

City *

State (Home)

Postal Code

Email (Primary) *

Phone-Phone (Primary) *

Anything we need to know allergy related or otherwise?

Registration *

One Child per class - $ 20.00

Family (2,3,4 kids) per class - $ 36.00

Sponsor - $ 54.00

Total for this participant

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province

Postal Code