Island In Time Please RSVP First Name Last Name Contact Number Email Date November, 13-15, 2015 Women Attending 1 2 3 4 5 Cost per person Payment method Check or Cash Please mail to An Island in time 261 Derby Ave. Orange, CT 06477 Credit card Name on card Credit Card number Expiration date month/year CVV (3 digits on back of card Amex 4 digits on front of card) Billing Address City, State, Zipcode Amount Sponsorship opportunities: I would like to be an event sponsor for I would like to sponsor a women who can't afford to come I would like to give a donation This page uses 128 bit SSL encryption to keep your data secure.
