Brave New Voices Payment

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BNV Participant Name

First

Last

Phone Number

Name on Debit/Credit Card

First

Last

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Square

Card

Name on Card

I agree to be charged $550.95 for the cost of the BNV trip and understand that this cost does not include any extra bag fees, select meals over the weekend, or pocket money which I will need to cover.

Price - $550.95

Total

$0.00