Diocese of Springfield in Illinois

Qty

Description

Amount

Total

Legion of Valor Overnight Registration

$135.00

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Scholarship Code

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Total: $0.00

Donor Details

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

E-mail: *

A receipt will be e-mailed to this address.

Parish Name *

If registering more than one person, enter the additional names here

Please separate each name with a comma

I would like to receive email updates on Legion of Valor news and upcoming events as well as major diocesan announcements.

Donor Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *

Name on Account: *

Routing Number: *

Account Number: *