General Payment Form

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Use this form to pay by credit card through PayPal or Print and Mail with your check or money order

*First Name:

*Last Name:

Company

*Address:

*City:

*State:

*Zip:

Phone:

Voice
TTY
VP
CapTel

*E-Mail:

Valid e-mail address is req`d.

Payment Information

Type of Payment

General Donation
Edna Shipley-Conner Newcomer Fund
Website/Publication Advertising
ALDAcon Sponsorship
ALDAcon Exhibitor Fee
ALDAcon Donation
Other

Other

Use these spaces to enter any additional description of your contribution and fill in the amount.

*Enter Description then Amount

Grand Total:

Payment Method

Payment Method

PayPal (use PayPal funds or Credit Card)
Check or Money Order (Print and Mail)

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