December 3-Impact Wednesday Registration

Name

This address will receive a confirmation email

Number of Adults Attending

Number of Children Attending (K-5th)

Number of Students Attending (6th-12th)

Number of Infant-PreK Needing Childcare

Chic-fil-A Choices:

Sandwich, Spicy Sandwich or Nuggets

All meals come with Waffle Potato Chips and a Chocolate Chunk Cookie.

Please Specify SANDWICH, SPICY SANDWICH or NUGGETS Per Person

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please make meal orders by Tuesday at noon.