2022 A&R Summer Picnic

This is ONLY for registration with credit card payment for the A&R Summer Picnic. If you wish to pay by check, then do NOT fill this out, fill out the paper form and mail it in to the A&R Office...you can also pay in person at the A&R Office.

Full Name *

Home e-mail Address *

Cell/Home Phone # *

Number of Tickets ($20/Active Member, $33/Retiree) *

Total Amount of Payment

Type of Credit Card *

Credit Card # *

Security Code for the Credit Card *

Expiration Date of the Credit Card *

Month

Day

Year

Address Associated With The Credit Card *

City Associated With The Credit Card *

State Associated With The Credit Card

Zip Code Associated With The Credit Card *

By checking this box I agree to have A&R charge my identified card for the cost of this event as identified above

I agree