2012 CAPI Conference Registration Payment Form

Registrants may choose to mail a check or money order, submit a payment via PayPal or complete the credit card authorization form to pay for their 2012 CAPI Conference Regisration fees. A late fee of $25 will be assessed to all registration payments not completed by March 1, 2012. Instructions for each of the three payment options are listed below.

 

Home » 2012 CAPI Conference » Application Forms | Payment Authorization Form

Mail CAPI Conference Registration Payment

If you would like to mail a check to pay for your registration fees, please make sure to include the name(s) of the registrant(s) the payment should be applied towards on the memo field of the check and send it to:

Las Vegas PRIDE (SNAPI)

CAPI Conference Registration
4001 S. Decatur Blvd. #37-540
Las Vegas, NV 89103-5800

Pay via PayPal

To pay via PayPal, please complete the form below for each registrant:

Registration Type (*):

Registrant Name (*):



Pay With a Credit Card

Fields marked with and asterisk ( * ) are required.

Name On Card: *

Registrant Name: *
(The registrant to credit payment to.)

Email Address: *

Phone Number: *

Billing Address: *

City: * State: * Zip Code: *

Credit Card Information


Credit Card Type: *

Credit Card Number: *

Credit Card Expiration: * / CVV Security Code: *

Amount to Charge: *

Comments/Special Instructions:


Authorization: As the credit card holder, I authorize Southern Nevada Association of PRIDE, Inc. d.b.a. Las Vegas PRIDE to charge my credit card for the amount selected above. *

Submit Form