Spring 2024 BAT Registration Payment

Fields marked * require an entry.

Payment Amount:

I want to add 3.95% to offset credit card fees in support of domestic violence survivors.:

$0.00

Total:

$300.00

Name of training registrant(s) -- if different than payment info below:

I would like to receive mail from Raphael House:

Yes

I would like to receive monthly updates by email:

Yes

Contact Information

Company:

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Work Phone:

Email:*

Credit Card Information

Card Types Accepted:
Visa

Credit Card Number:*

Card Security Code:*

Expiration Date:*

Electronic Signature:*

I agree to pay above total amount according to card issuer agreement. Once the transaction has completed successfully, a confirmation receipt will be sent to the email address entered.

Refunds are not available, however we may be able to apply your payment to future training sessions. Questions? Please contact Elizabeth McKeever at (503) 243-5126.