Gala Registrant Personal Information
First Name
*
Last Name
*
Mobile Number
*
Email Address
*
Are you part of Action Chapel North America?
*
Yes
No
If yes, what branch?
*
Action Chapel Pennsylvania
Action Chapel Virginia
Action Chapel Baltimore
Action Chapel Silver Spring
Action City Church Perry Hall
Action City Dallas
Action Church Tulsa
Other
If other, please write the branch below:
*
If no, please advise what church are you with below:
*
Do you have any food allergies or dietary considerations we should know about?
*
Yes
No
If so, can you advise us what it is?
*
Gala Registrant Payment Information
What type of admission are you?
*
Adult Admission (19+) - ($105.00)
Youth Admission (5-18) - ($35.00)
Child Admission (0-4) - (FREE)
What payment type are you using?
*
Cash (Payment Plan Available)
CashApp (Payment Plan Available)
Venmo (Payment Plan Available)
Credit Card/Debit Card (No Payment Plan Available)
Tip: ALL PAYMENTS ARE DUE BY SUNDAY MAY 31, 2026!
Are you paying in full today?
*
Yes
No
Tip: ALL PAYMENTS ARE DUE BY SUNDAY MAY 31, 2026!
If no, are you planning on paying in full later or will you require a payment plan?
*
Paying in Full Later
Require Payment Plan
Tip: ALL PAYMENTS ARE DUE BY SUNDAY MAY 31, 2026!
If paying in full later, when will you submit the total payment?
*
Tip: ALL PAYMENTS ARE DUE BY SUNDAY MAY 31, 2026!
If requiring an adult admission payment plan, how many payment installments will you need?
*
3 Payments of $35
5 Payments of $21
7 Payments of $15
No payment plan needed. Paying in full.
Tip: ALL PAYMENTS ARE DUE BY SUNDAY MAY 31, 2026!
If requiring a child admission payment plan, how many payment installments will you need?
*
5 Payments of $7
7 Payments of $5
No payment plan needed. Paying in full.
Tip: ALL PAYMENTS ARE DUE BY SUNDAY MAY 31, 2026!
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