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 Bookstore linkPlease click Send before you process your payment. Thank you!
November 3, 2017, 1310 W. Betteravia Road, Santa Maria, CA 93455. Call 805.714.0786. Doors open at 5:30 pm, dinner served at 6 pm.

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 process a payment of $25 for each ticket. Ticket price includes entry in all three door prize drawings. Thank you!

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