Event Registration Payment Form

event
date
the date and/or time the event starts and/or ends
desc
description of the event
{event}
{date}

{desc}
org
ex: SWANA
Non-Member Price
Member Price
Price
o1n
Name of additional offering 1
o1p
Price of additional offering 1
o1d
Description of additional offering 1
o2n
Name of additional offering
o2p
Price of additional offering
o2d
Description of additional offering

Register Attendee
Future {org} Member
${nonmemberPrice}
Quantity
Register Attendee
Current {org} Member
${memberPrice}
This is a discounted rate offered only to {org} members!
Quantity
Register Attendee
${price}
Quantity
{o1n}
${o1p}
{o1d}
Quantity
{o2n}
${o2p}
{o2d}
Quantity
Transaction Fee
${amount_to_balance}
For a payment of ${total_with_fee}, {org} would pay a transaction fee of ${amount_to_balance}.
Cover Fees

Total

USDDescription

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please list the names of all attendees being registered.*
Send Confirmation Email To:*
total_before_fee
fee
total_with_fee
user_selected_fee
payment_total
amount_to_balance
hf
hide the fee & the option to cover the fees
amount_greater_than_zero
zero or 1 depending
Should be Empty: