Area Wide Training Registration Fee
Alpha Xi Delta, Beta Alpha Chapter


Legal First Name: Legal Last Name:
Email Address Phone number

A payment receipt will be sent to the email address listed above for payments made via credit or debit card upon transaction authorization.

Card Type Card Number
Name on Card Card Expiration  
CVV2: Credit Card Billing Zip Code
Amount    Registration Fee
Comments:
If you have questions, please contact:    
Emily Zhou
(817) 235 - 0233