Dîner de Perfusion Membership Registration
PLEASE NOTE: Members MUST be at least 21 years old. Additional registration fields will appear based on selected options. Black Attire Strictly Enforced.
Member Information:
Name
*
First Name
Last Name
Mobile Phone Number - We will text you info (Location, etc)
*
-
Area Code
Phone Number
Confirm Mobile Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Confirm Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth:
*
-
Month
-
Day
Year
Date
Uploads
To verify identity and age, please upload a photo of you holding your ID and of the ID by itself ensuring that the ID information is fully visible. See examples below.
Upload Photo Holding ID
*
Browse Files
Cancel
of
Upload ID
*
Browse Files
Cancel
of
Legal Disclaimers & Acknowledgements:
By submitting this form, I agree with all Dîner De Perfusion Policies as well as the below. Please review policies at http://www.dinerdeperfusion.com/policies.
PLEASE NOTE: Dîner De Perfusion events are Washington, DC Initiative 71 (i71) Compliant. Dîner De Perfusion DOES NOT sell cannabis/marijuana products. With events registration, guests, who are interested, may be gifted up to the lawful amount of cannabis products. All guests, partners and vendors are expected to comply with i71 rules and regulations.
*
I have Read, Understand and will Comply with the above statement.
MEMBERSHIP REQUIREMENT: Dîner de Perfusion holds Members-Only Events. I understand that to attend Dîner De Perfusion Events, an active Membership is required.
*
I have Read, Understand and Agree to the above MEMBERSHIP REQUIREMENT POLICY
NO REFUND/CHARGE BACK POLICY: I am solely responsible for, and authorized to make, payment for this purchase of service(s), event registration tickets (and/or monthly membership. I understand that there is a no refund/all sales final policy. Should a charge back or dispute of any kind occur for any reason, I agree to be solely responsible for up to 250% of the disputed/charged-back amount in addition to any court costs and legal fees (if necessary).
*
I have Read, Understand and Agree to the above NO REFUND/CHARGE BACK POLICY.
Payment Information
This transaction will appear on your statement as HNC Enterprises, Incorporated
Membership Options
*
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DDP Membership (Monthly)
(
$
29.99
for each
month
)
Total
$
0.00
Email
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Enter Coupon Code
By submitting this form, I hereby authorize payment to this merchant by credit or debit card for the monthly membership. I will take full responsibility for this payment in the event the card CARDHOLDER or AUTHORIZED USER rejects or disputes the charges and will pay merchant in accordance with its No Refund/Charge Back Policy within 48 hours.
*
I AGREE
Submit
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