Individual Payment Processing

Please complete this short form so that we have all the pertinent information needed to process your payment.

Once payment is received at OGS, we will issue a formal receipt and send via email (could take up to 1-2 weeks).

Should you encounter any issues or have any questions about paying via this link, please contact OGS Executive Director, Mary Olhausen: oregongeriatrics@comcast.net / 503-880-7383.

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Contact Information

Name*

First Last

Mobile Phone*

Email*

Are you paying on behalf of an individual or organization?*

Individual

Organization / Exhibitor

Organization / Exhibitor Name**

Reason for Payment*

Silent Auction

Exhibitor

Conference Expense

Scholarship

Other

Billing Address*

Street Address Address Line 2 City State ZIP Code

Payment

Amount*

Total

Payment Method*

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name