Event Registration Events "*" indicates required fields Location*Select an optionBriarcliffJefferson ValleyBriarcliff Events*Select an optionSole Support LectureJefferson Valley Events*Select an optionBreakfast with SantaThankful for BingoSole Support Lecture* Member : FREE Non-Member : FREE Wednesday, December 10th | Conference Room | 11AMName* First Last Date of Birth* MM slash DD slash YYYY I'm a...* Member Non-Member Email Address* Cell Phone Number*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How did you hear about this event? (Check all that apply) Email Campaign Friend or Word of Mouth Internal Signage (TV, Signs, Posters at the Club) Print Advertising (Newspaper, Magazine, etc.) Simply Motherhood Social Media Website Thankful for Bingo Quantity Price: $25.00 Quantity Please enter in the number of tickets you would like to reserve. Please also note, there are no refunds. Breakfast with Santa Adult Quantity* Price: $20.00 Quantity Please enter in the number of tickets you would like to reserve. Please also note, there are no refunds. Tax is not included.Breakfast with Santa Child 2 & Older Quantity Price: $12.00 Quantity Please enter in the number of tickets you would like to reserve. Please also note, there are no refunds. Tax is not included.Breakfast with Santa Child under 2 Quantity Price: $0.00 Quantity Please enter in the number of tickets you would like to reserve. Please also note, there are no refunds. Tax is not included.Payment Info* Credit Card on File (Members Only) Credit Card Ecash (Members Only) * Please note, we do not take credit card payment online. Someone from Club Fit will call you to collect payment. There will be no refunds. Your sale is not final until your payment has been confirmed. You will receive a receipt to the email address provided above.Total
