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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: [email protected]
