Please e-mail or fax this information to Dr. Robert P. Ellis
robert.ellis@colostate.edu
CRWAD dues and meeting registration
fees may be paid by credit card. If you are paying meeting registration
fees a completed pre-registration form must
accompany the credit card information.
Accepted cards are: MasterCard, VISA, American Express,
and Discover credit cards.
If you would like to make payment by credit card please complete and
e-mail or fax the following information.
Credit Card Number ________________________________________
Expiration Date __________
Verification No. (This is the 3 digit number - it may follow
a 4 digit number- which appears on the signature strip on the back of the
card) ______
Name on the card _______________________________________
Street Address _________________________________________
Zip/Country Code _______________
Type of credit card (
Visa, MasterCard,
American Express, or Discover) _______________
What are you paying (Dues and/or registration) _________________________________________
Amount you are paying _______________