Pre-Authorization Form
All information will remain confidential
* Required
Event Title:*:
First Name:*
Last Name:*
Event Contact:*
Start Date:
End Date:
Credit Card Holder Information
First Name:*:
Last Name:*
Email Address*:
I hereby authorize the San Diego County Office of Education to charge my credit card for the following amount(s):
Total Amount: $
Billing address on credit card:
Zip Code:*:
Phone Number:*
Card Type:*
Card Number:*
Card Expiry:* Month: Year:
If you have any questions with completing this form, please contact at: .