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RE Payment

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  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Programa | Program
  Escoja los que apliquen | Choose which apply
  Comunión | Communion Confirmación | Confirmation Adultos-RICA | Adults-RCIA
  
  Para Cuantos? | For How Many? REQUIRED
  Apunte el nombre del niño/joven/adulto al que se le aplicará el pago. | Indicate the child/teen/adult the payment would be allocated to.
  Please fill out this field.
  
  Persona | Person 1
  
  Nombre|Name REQUIRED Please fill out this field. Please enter valid data.
  
  Persona | Person 2
  
  Nombre|Name REQUIRED Please fill out this field. Please enter valid data.
  
  Persona | Person 3
  
  Nombre|Name REQUIRED Please fill out this field. Please enter valid data.
  
  Persona | Person 4
  
  Nombre|Name REQUIRED Please fill out this field. Please enter valid data.
  
  Total:
  
  Submit
  
  Proceed to Payment
  
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