Please print this page as confirmation of the details you provided on the previous page. If information is incorrect, please return to the form as noted below and resubmit data. 

Transaction finalized upon approval of credit card information.

Your registration will be confirmed by e-mail when we have received credit card information via telephone (717.545.4761; Monday-Friday, 9 a.m.- 4 p.m.). 

Board of Directors' Meeting: Board Lunch

Turkey Meal: Turkey

Vegetarian Meal: Vegetarian

Printing Invoice #: Printing#

Printing Invoice Amount: $PrintingAmt

Office Rent Invoice #: Rent#  

Office Rent Amount: $RentAmt

VISA: VISA  

MasterCard:  MasterCard

DISCOVER:  Discover

Name: Name

Mailing Address: Address

City: City         State: State    Zip: Zip

Email: Email

Telephone #: Phone

Cell #: Cell Phone

Comments:  Comments

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Pennsylvania Council of Churches 900 S. Arlington Avenue, Suite 211A, Harrisburg, PA 17109-5024

Telephone 717.545.4761 Facsimile 717.545.4765 E-mail pcc@pachurches.org 

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