1 Start 2 Complete Credit Card Registration Form ONLY...if you are paying by check do NOT use this registration form A&R Summer Picnic at La Bella Vista380 Farmwood Rd, Waterbury, CTSeptember 1, 202311:30AM, Lunch opens at 12:30PM $20.00 A&R Member $33.00 A&R Retiree Name of A&R Employee Home e-mail * Cell Phone # * # of Active A&R Member tickets at $20 each * - Select -1234 # of Retiree Tickets at $33 each - None -1234 Total Cost For All Tickets Type of Credit Card * - Select -VisaMasterCardAmExDiscover By checking this box, I am agreeing to allow A&R to process payment from my listed card for tickets to this event. The charge may appear on your bill as "Am. Fed of Teachers" rather than A&R. * I agree Name on the Credit Card * Full Address Associated with the Credit Card * City associated with the Credit Card * State ZIP Code associated with the Credit Card * Credit Card Number * Card Expiration Date - Use Format (MM/YY) * 3 or 4 Digit Credit Card Security Code * Leave this field blank