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2010 Registration Form

Budd Creek Retreat--April 8-11--$100 *
Searcy Extravaganza $130 Nov 5-6, 2010 *
First Name *
Last Name *
Address *
City *
State *
Zip Code *
Phone Number *
Cell Phone Number
Work Phone
Email *
T-Shirt Size *
Please charge my credit card for the full amount of my ticket *
Payment Plan: Please check yes if you accept the guidelines for the payment plan found on the 2010 Extravagnza page..Tickets are non refundable *
Please use my credit card you have on file *
I will call 501-278-5700 with my credit card information within 48 hours. I am aware that if I do not call within 48 hours with my credit card information my registration will be discarded. *
Please use the following credit card *
Name on Credit Card
Credit Card Number
Expiration Date
Three Digit Security Code on Back of Card
Submitting this form does not secure a ticket. Please allow 48 hours before calling to verify that we have received your registration. 501-278-5700 *