Hills Alive Member

Payment may also be made by check and mailed to:
LifeLight Communications
1412 S Minnesota Ave
Sioux Falls, SD 57105
When paying by check please include the information from this form with your check.

Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Size of T-shirt #1

*

Please select one option.

Small Medium Large X-Large XX-Large

Size of T-shirt #2

*

Please select one option.

Small Medium Large X-Large XX-Large

Payment $1,000.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Payment may also be made by check and mailed to:
LifeLight Communications
1412 S Minnesota Ave
Sioux Falls, SD 57105
When paying by check please include the information from this form with your check.

Please Fix the Following

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