Parents’ Day Banquet Online Registration To register for the banquet, please fill out the following form for each person.Name* Honorific First Last Title*Organization*Email* Phone*Invited By:*Please select from the list on this boxTop 12 Awardee CommitteeACLCDC Family ChurchFFWPU USA National HeadquartersNew Hope (Maryland) Family ChurchNorthern Virginia Family ChurchNorfolk/Richmond Family ChurchThe Washington Times FoundationUPF USA DC OfficeUPF USA National HeadquartersWFWPOtherOther:*Please select one*I am a 2016 Parents' Day awardeeMy parent is a 2016 Parents' Day awardeeI'm paying at the door (Cash or check only)Paying by credit cardEvent Fee (Per Person)* Price: $10.00 I want to make additional donation: Total $0.00 Payment by Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Cardholder Email* Cardholder Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code