Event Registration - Prestonwood Christian Academy

Indicates Required Field

Personal Information

First Name This is a Required Field

Last Name

Address

City

State

Zip Code

Format: 90210

Primary Phone This is a Required Field

Format: 999-999-9999

Secondary Phone

Format: 999-999-9999

Email Address This is a Required Field

Format: example@domain.com

PCA Student(s) Affiliation

The $150 Individual Brick

8” x 4” Terra Cotta brick. 14 Characters per Line. Two Lines Maximum.

Brick Option

$150 Brick [+$150.00]

Line #1 Text

Individual Names Only. 14 characters max

Line #2 Text

Individual Names Only. 14 characters max

The $500 Brick

8” x 8” Terra Cotta brick. 14 Characters per Line. Three Lines Maximum.

Brick Option

$500 Brick [+$500.00]

Line #1 Text

14 characters max

Line #2 Text

14 characters max

Line #3 Text

14 characters max

The $1000 Brick

12” x 12” Terra Cotta brick. 20 Characters per Line. Three Lines Maximum. Lion Mascot Centered on each Brick.

Brick Option

$1000 Brick [+$1,000.00]

Line #1 Text

20 characters max

Line #2 Text

20 characters max

Line #3 Text

20 characters max

I would like to place another registration.

Please use this same information on the next form.