MyEventRunner - Event Public Fill

Annual "Interceding for Children"
Fundraising Dinner

Saturday November 12, 2016

Northbank Center
432 N Saginaw St.
Flint, MI 48502

Your Information

First Name:

Last Name:

Badge Name:

Email:

Club Name:

Preferred Phone:

Secondary Phone:

Address 1:

Address 2:

City:

Zip/Postal Code:

Country:

State/Province:

I consent to the collection, storage, and use of my information by Motherly Intercession as described in this Privacy Policy. I understand that I may receive emails regarding this event and other relevant information, and can opt out at any time. Required

Your Partner/Guest Information

First Name:

Last Name:

Badge Name:

Email:

Club Name:

Preferred Phone:

Secondary Phone:

Address 1:

Address 2:

City:

Zip/Postal Code:

Country:

State/Province:

I consent to the collection, storage, and use of my information by Motherly Intercession as described in this Privacy Policy. I understand that I may receive emails regarding this event and other relevant information, and can opt out at any time.

Select Options