Dungeons and Dragons Registration and payment for Virtual Dungeons and Dragons, Thursdays 3:30pm-5:30pm. Are you a member of the Holter Museum of Art?* Yes No How many participants are you paying for?*Please enter a number less than or equal to 4.Maximum is 4. If you would like to sign up more than 4 participants for a session, you are welcome to fill out and submit the form again or contact email@example.com. If you are filling out the form for participants who you are NOT the primary parent-guardian for, please include an email and phone number for the appropriate parent-guardians so that our instructors are able to contact and talk to an adult for any technical difficulties.Participant, member Price: $100.00 2nd Participant, member Price: $100.00 3rd Participant, member Price: $100.00 4th Participant, member Price: $100.00 Participant, non-member Price: $150.00 2nd Participant, non-member Price: $150.00 3rd Participant, non-member Price: $150.00 4th Participant, non-member Price: $150.00 1st Participant's Name* First Last 1st Participant's Age2nd Participant's Name* First Last 2nd Participant's Age3rd Participant's Name* First Last 3rd Participant's Age4th Participant's Name* First Last 4th Participant's AgeFirst Parent-Guardian's Name* First Last First Parent-Guardian's Email* First Parent-Guardian's Phone Number*1st Participant's Social Emotional Well-being Is there anything our instructors need to know about the participant that would help us provide the best experience for them?2nd Participant's Social Emotional Well-being Is there anything our instructors need to know about the participant that would help us provide the best experience for them?3rd Participant's Social Emotional Well-being Is there anything our instructors need to know about the participant that would help us provide the best experience for them?4th Participant's Social Emotional Well-being Is there anything our instructors need to know about the participant that would help us provide the best experience for them?Parent-guardian Contact InformationAdditional Parent-guardian's contact information; please include both email and a phone number.Total $0.00 Contact Email* Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Credit Card* Card Details Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.