NOVEMBER 3, 2017 — 1310 W. BETTERAVIA ROAD, SANTA MARIA, CA 93455 CALL 805.714.0786

REGISTRATION FORM: Lights On Banquet – 2017

Lights On Banquet Registration Form

Gold AmbassadorSilver AmbassadorBronze AmbassadorLighthouse MemberRadio ListenerPodcast SubscriberOther

Your Name (required)

Your Email (required)

House number and Street

City

State

Zip Code

Contact Number

Church

Number Attending In Your Group

Your Message

Please read before you click send:

After you click Send, this page will reset to blank. That’s okay. Your registration has been sent. To purchase your tickets, come back to this portion of the page and click on the “Church Bookstore” link, select “Banquet Ticket,” and process your order online: Church BookstorePlease click Send before you process your payment. Thank you!
November 3, 2017, doors open at 5:30 pm, dinner served at 6 pm. 1310 W. Betteravia Road, Santa Maria, CA 93455. Call 805.714.0786.

ALTERNATE PAYMENT OPTIONS: You may use the Donate button, but this is not tax deductible since the value of the meal at $25 is within $1 of the full cost of your ticket. Click the Donate button (see upper right column of this page) and if your order is received on or before September 1, process a payment of $25 for each ticket. Thank you!

Or you can mail it to The Brain Massage Show, 1310 W. Betteravia Road, Santa Maria, CA 93455. Thank you!