Durga Puja Registration (Saturday October 12th 2024)
Name
First Name
Last Name
Email
example@example.com
Zip Code
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
prev
next
( X )
Adult Entry
$
50.00
Number
1
2
3
4
5
6
7
8
9
10
Kid (5-12)
$
30.00
Number
1
2
3
4
5
6
7
8
9
10
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
Should be Empty: