Couples event YJP Registration Form with paypal payment option and mailchimp integration

Full Name*

First NameLast Name
E-mail:*
Cell Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Comments (allergies, questions, concerns...
Number attending*
Donate via Paypal $20 per couple $56 Sponsor

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USDPaypal amount here
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