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Event Payment


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Enter event payment for one or more of the choices below.

Amount
NABA: 
Golf Outing: 
Northland Fourth of July Parade: 
Rt. 161 Task Force: 
Luncheons: 
Other: 

Contact Information
* First Name: 
* Last Name: 
* Address1: 
Address2: 
* City: 
* State: 
* Zip: 
Primary Phone: 
* E-mail address: 

Credit Card Information
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* Credit Card Number: 
* Credit Card: 
* Expiration Month: 
* Expiration Year: 
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Refund Policy: