Please complete form and hit SUBMIT button after payment information is entered. You will receive an email to confirm your submission was received. If you have any questions or concerns, please contact Tina Spassione at rosellecatholictrickytray@gmail.com.
prev
next
( X )
Entrance Fee
Includes refreshments and chance to win one of many door prizes.
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Value Packs
A $75 VALUE! Includes 2 Green = $10 (Valued $15-$35) • 11 Pink = $15 (Valued $36-$75) • 7 Red = $15 (Valued $76-$150) • 4 Blue = $15 (Valued $151-$250) • 2 Yellow = $20 (Valued $251+)
$
60.00
Quantity
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
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: