AFFIRM 2019 Payments

*Name of Congregation
*First Name
*Last Name
*Email
*List the first and last name of each participant and how much should be applied to their account.

For example:
Johnny Smith - $50
Jane Smith - $100

If you are using this form to pay for a staff room, please notate that in this field.

*Total Payment Amount
$
Only number values are allowed
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