Elmira Workshop Registration & Payment

This form is only for members who wish to register & pay at the same time.  After completing this form you will be taken to our Paypal system to complete your registration.  Please be aware that your registration is
not valid unless it is received WITH the payment.

         
First Name Last Name
Address
City St Zip
Phone
Email
Zonta Club
Special Status:
  Delegate Past District Governor
  Alternate District 2 Board Member
  First Timer District Committee Chair