Celebration of Distinguished Alumni Registration

Saturday, October 21, 2023 at Hardy Alumni Hall

6:30 p.m.

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Registration Information

Kindly fill out this form to register yourself and any accompanying guests who will be attending with you.

Name*

First Last

Maiden Name

Please include if applicable.

Relationship to Barton/ACC*

Email*

Primary Phone*

Please specify Home or Mobile below.

Phone Type*

Home Phone

Mobile Phone

Mailing Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Guest Information

Guests' Names

For the purpose of name tags, kindly provide the preferred full name of both yourself and your guests. Use the (+) icon to add more guests to this lists.

Appetizers and Ceremony

@ $25 per person

Who are you coming to support?

Total

Credit Card*

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Confirm Cardholder Name*

Billing Address*

Street Address City State / Province / Region ZIP / Postal Code Country

REMINDER:
Once you click "Submit," it may take a few moments for your transaction to complete. Please do not use the Back button or click Submit more than once; otherwise, you could trigger duplicate charges on your credit card.

This field is for validation purposes and should be left unchanged.

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