REGISTRATION FORM FOR MASSACHUSETTS COUNCIL OF CHURCHES

ECUMENICAL DINNER, MAY 21, 2008

USE THIS FORM ONLY IS USING A CREDIT CARD

Name:

Address:

Phone:                Email: 

Denomination  or Organization you are representing

Number of Person  @ $25 per person   

Charge Visa       or       MasterCard

 Number      Expiration Date      Verification Code 

 Name as it appears on the card