Jackpot Registration and Payment Form
CenTex BBQ Roundup
Competitor Information
Registration Number
Date
*
-
Month
-
Day
Year
Date
Name
*
Team Name
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Categories
Beans Jackpot Entry
Dessert Jackpot Entry
Chef's Choice Jackpot Entry
Competition Rules Acknowledgment
*
I acknowledge that I have read and understand the CTBR Jackpot Competition Rules and agree to comply with all event requirements and judging procedures.
How will you pay?
Pay now with credit card
Pay at the event
Pay Jackpot Entry Fee
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next
( X )
Beans Jackpot
$25.00
$
25.00
Quantity
1
Item subtotal:
$0.00
$
0.00
Chef's Choice
$25.00
$
25.00
Quantity
1
Item subtotal:
$0.00
$
0.00
Dessert Jackpot
$25.00
$
25.00
Quantity
1
Item subtotal:
$0.00
$
0.00
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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