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Community Guest Lectures

Mendelevich RSVP

See flyer with details here

Tickets $20* Sponsor $100
Personal Information:
Full Name*

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*
E-mail*
Reservation Information:
Persons*

$20 per Adult

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Expiration Month	Expiration Year

Donation:

100 Sponsor 1800 Event Sponsor
Total

$0.00
Comments:
Should be Empty:

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