We will not charge your credit card until the course has been confirmed with sufficient registrations.

Your submission of this credit card charge authorization form to GFTW is authorization to charge for the course fee.

Event or Course Name:                   

      Alternate Course Name:                  

      (Please list an alternate course you would take, if your first choice is not available, or enter None.)

Amount authorized:                               

Name of person registering:                  

Your email address:                      

Your phone number:                    

Name of cardholder as printed on credit card:                      

Credit Card Number:                                                     Visa or Master Card only.

             Please re-enter for validation purposes:                  

Credit Card Expiration Date:                                               

Note: Your Credit Card will not be charged until we have verified that the course will be conducted.  This form also serves as your registration.

Billing Address for the Credit Card:

 Street:                                                             

 City:                                                                

 State:                                                              

 Zip:                                                                 

Please save a copy for your records before mailing.

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