Breakaway payment

Registration submitted!  See you on March 3 for Breakaway!

If you are paying by check, please make payable to "Wayne Presbyterian Church", note "Breakaway" in the memo line and drop off or send in to the church finance office.

If you are paying by credit card online, please fill in form below - only Visa & Mastercard payments accepted at this time! "Donation Amount" is the total amount you want charged to your credit card for the event.

Pricing for Event (per person):

Adults - $165

Youth (12-17) - $50

Children (8-11) - $40

Children (7 and under) - Free

 

Deposit of $50 (per family) due with registration, final payment due February 27, 2017.

If you would like to contribute to a scholarship fund for the Breakaway Retreat which will be offered to those who might not otherwise be able to attend, any amount will be warmly appreciated. Please include in payment.

First Name*  
Last Name*  
Email Address*  
Phone Number*
Donation Amount
$

Billing Information

First Name*  
Last Name*  
Address*    
City*  
State/Province
Country  
Postal Code*  
Credit Card Type*  
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Expiration Date*  /  
Please answer the simple math question below to submit the form.
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