Antioch Baptist Church - Washington, D.C. Trip Registration
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Single or Double Occupancy
*
Single
Double
My Products
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( X )
Deposit
Due March 11th
$
75.00
Single Room Full Payment
$
544.00
Double Room Full Payment
$
358.00
Single Room Remaining Balance
$
469.00
Double Room Remaining Balance
$
283.00
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
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