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Parents Day 2013 Registration

Events Schedule

* denotes required fields

Personal

Name:*

Email Address:*

Please list all Additional Guests that will be in Attendance (Please note that the fee for Parents Day is $30 per person)


Name of student:

Residence Hall of student:

Special Notes (i.e. - dietary restrictions, physical needs, etc.)


Address

Street:*

City:*

State:*

Zip Code:*

Telephone:


Payment Information

Data is encrypted for your protection.

Fee for Parents Day - $30 per person

Please enter the number of attendees: X $30
Total: $0

VISA    MasterCard    American Express    Discover

Card Number:    Exp. Date: (e.g. 12/14)

Name as it appears on card:

* Clicking Submit finalizes your order and submits your information *

For more information, contact Adam Wade at awade@louisburg.edu or (919) 497-3290.