Program Registration ~ MOHID ©

Convergence Culturelle Africaine

CP 332 Aylmer, Gatineau, Quebec J9H5E6, CA

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Program Information

LA DAARA de la CCA Register Here

Program Start Date: 09/17/2023 Program End Date: 06/23/2024

$285.00

1 Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

Province *

City *

Postal Code *

Cell Number

2 Add Registrants

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

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+ Add More Registrants

3 Payment

Payment Method

Credit/Debit Card

Name on Credit Card *

Credit Card Number*

Expiry Date*

CVV Code*

Bank Name

Name on Account *

Account Number*

Routing Number*

Account Type*

Monthly Recurring

Recurring Start Date*

Number of Months*

For Lifetime

Please note: You will incur a $1 charge if the recurring start date is not current date in order to verify the payment details provided. This charge will not be credited back to your account and you will receive a test transaction receipt for this amount.

Consent * Do you give Convergence Culturelle Africaine consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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Payment Summary

Program Fee

Total Registrants

Total Cost

Convergence Culturelle Africaine

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Program Information

LA DAARA de la CCA Register Here

1 Contact Information

2 Add Registrants

3 Payment

Payment Summary

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