Wednesday Dinner & Discipleship

Please fill out this form and click submit.
Cost: $6/person or $20/family
Cash, check, or online pre-pay accepted.
Please indicate the number of salad bar meals and the number of main dish meals you will need.
IF YOU CHOOSE TO PAY ONLINE THERE WILL BE NO REIMBURSEMENT FOR A NO-SHOW. IF YOU ARE UNABLE TO ATTEND WE WILL PROVIDE YOU A CREDIT FOR THE FOLLOWING WEEK.

Name

*

Email

*

This address will receive a confirmation email

Number of Main Dishes

Please select one option.

none 1 2 3 4 5 6 7 8 9 10

Number of Salad Bars

Please select one option.

none 1 2 3 4 5 6 7 8 9 10

IF YOU CHOOSE TO PRE-PAY ONLINE INDICATE BELOW. THERE WILL BE NO REIMBURSEMENT FOR A NO-SHOW. IF YOU ARE UNABLE TO ATTEND, WE WILL PROVIDE YOU A CREDIT FOR THE FOLLOWING WEEK.

Payment

Pay In-Person (0) 1 Person ($6) 2 People ($12) 3 People ($18) 4+ Family ($20)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form and click submit.
Cost: $6/person or $20/family
Cash, check, or online pre-pay accepted.
Please indicate the number of salad bar meals and the number of main dish meals you will need.
IF YOU CHOOSE TO PAY ONLINE THERE WILL BE NO REIMBURSEMENT FOR A NO-SHOW. IF YOU ARE UNABLE TO ATTEND WE WILL PROVIDE YOU A CREDIT FOR THE FOLLOWING WEEK.

Please Fix the Following

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