GWS Secure Payment Form

SECURE PAYMENT FORM

Use this form to make any kind of credit card payment to the GWS:

Please fill out all fields. We accept VISA, MasterCard, and American Express.

Need to split your payment? (For example, the government is paying your conference registration, but you have to pay for your own field trip.) If so, use the "Special Instructions" box below to give us your personal credit card information, or to otherwise explain how the balance will be paid.

Purpose of payment For example: event registration for Jane Doe (specify which conference), membership renewal for John Doe, etc.
Amount to charge to this card: $
Card number
Expiration date (mm/yy)
CVV - the last 3 digits (4 digits on American Express cards) printed on the signature panel on the back of your card
Cardholder's name (name as it appears on card)
Cardholder's BILLING address, contact phone number, and e-mail The cardholder will receive a receipt.
Special instructions Use this box to tell us anything else we need to know about your payment. If you are paying for multiple event registrations on a single card, please list the registrants' names separately here, along with the amount you are paying for each.

Thank you! If you have any questions, please contact us:

The George Wright Society

P.O. Box 65

Hancock, MI 49930-0065 USA

1-906-487-9722