CREDIT CARD FORM - webservices.sos.state.tx.us · By signing here, you authorize the above amount...

Secretary of State

CREDIT CARD FORM31st Annual Election Law Seminar for Cities, Schools and Other Political Subdivisions

December 4 - 6, 2019

Name on Card:

County/Entity:

Billing Address:

City:

Phone #:

State: Zip Code:

Email:

Registration Confirmation and Seminar Informationwill be sent to email address provided below.

(1): Attendee's Name E-mail:

(2):

(3):

(4):

(5):

If faxed or postmarked after November 1, the Late Registration Fee is $250.00

Registration Fee(s) @ $250.00

Total Due:

Credit Card #:

Type of Card:

Exp. Date: 3-digit CVV Code or4-digit CID Code:

By signing here, you authorize the above amount to be charged to your credit card.

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Fax, mail or email to: Office of the Secretary of State, Attn: Special ProjectsP.O. Box 12060, Austin, Texas 78711-2060 Fax: 512.463.7552 | E-mail: specialprojects@sos.texas.gov