2022 Stop Violence Conference

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REGISTER 4 ATTENDEES, GET THE 5th FREE!

Email Julian for the discount code!

For those who need to pay by check, register multiple attendees from the same organization, or have any other questions about registration for the Stop Violence Conference, please contact Julian Rangel.

[email protected] (preferred) or calling 817-502-7125

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For those paying by check, please contact Julian Rangel at [email protected] (preferred) or 817-502-7125. You will be manually registered.

For those paying by credit/debit card, please continue below.

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Please fill this out with the information of the person/organization/agency/department providing payment for the registrant(s) previously entered.

Payment Contact Info

First Name*

Last Name*

Agency/Organization

Billing Address*

City*

State*

Zip Code*

Email Address*

We will never share your email address. Ever.

Phone*

$10
$25
$50
$75
$100
$

Donation will repeat monthly.

$10
$25
$50
$75
$100
$

Payment Details

Payment Type:

Credit Card

eCheck

PayPal

Bank Account*

Name on Account*

Bank Routing Number*

Bank Account Number*

Card Number*

Security Code*

Expiration Month*

Expiration Year*

Name on Card*

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Thank You!

We look forward to seeing you July 26th - 27th!

For any questions, concerns, or inquiries, please send an email to either

Rachel Gilbert: [email protected]

Julian Rangel: [email protected]

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