PreAuthorize Contact | BetterUnite

Register to Participate in Event

This class will be on Saturday mornings starting at 9:30 am and going until 12:30 pm. The location is still being decided. This page will be updated when the location is arranged. An email will go out about the location also. If you have any questions, please reach out to info@namitarrant.org

Esta clase será los sábados por la mañana a partir de las 9:30 am y hasta las 12:30 pm. La ubicación aún se está decidiendo. Esta página se actualizará cuando se organice la ubicación. También se enviará un correo electrónico sobre la ubicación. Si tiene alguna pregunta, comuníquese con info@namitarrant.org

First Name*

Last Name*

Email*

Cell Phone *

Age and Diagnosis*

Any further information you would like to share:*

Relationship to Consumer*

Who do you have as a support person?*

Company Name

Street

City

Zipcode

Occupation

Employer

Spouse Fullname

Spouse Occupation

Spouse Employer

Consumer's Name

Name on Card*

Card Number*

Expires*

CVV*

Zip Code*

Opt-in to cover the service fees associated with your purchases

Cell Phone (optional)

AUTHORIZE CARD

* Registering your credit card does not charge your card at this time. Preauthorization of your credit card makes purchasing or checking out at your event easy and quick. By registering (or preauthorizing) your credit card here, you're giving the event organizer permission to charge your card for items that you agree to purchase or donations you agree to make while at the event. Service fees will be applied in addition to any total if you have opted in to cover those fees above.

* Have Non-US Card?