EVENT INFORMATION
If other, please specify:
# of Single Tickets:
*TOTAL COST: $
Please enter the total cost of all your tickets above.
Consult the event page on
the website
for ticket costs,
or contact the IDRF office, toll free at 1-866-497-IDRF.
Arragements for your guests must also be made with the IDRF Office.
PERSONAL INFORMATION
Please note that a tax receipt for the event will be made out to the name and address above.
If you would like a tax receipt made out to a different name and address, or to each of your guests,
please enter their information below, or contact the IDRF office, toll free at 1-866-497-IDRF.
OTHER INFORMATION:
Dietary restrictions:
Comments or Suggestions:
This secure online form is for credit card purchases only.
If you wish to buy tickets by mail or over the phone, please click here for more
information on how to contact the IDRF office.
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Total Amount to be Charged:
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Card Number |
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CVV |
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Card Expiry |
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Name on Card |
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To ensure the security of your personal information you have been taken to a secure form on a secure server hosted by our payment
provider - Paypaq™ Solutions Inc. Paypaq™ Solutions Inc. is a validated Service Provider under Payment Card
Industry Data Security Standards (PCI) (www.paypaq.com). Look for the locked
lock on your browser's status bar or https: to ensure you are submitting your payment information on a secure form.
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This form is for online, secure payments ONLY. For security purposes, please do not fax this form.
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