Friendship Ambassadors Foundation
299 Greenwich Avenue, Greenwich, CT. 06830 • www.faf.org • • 1-203-542-0652; -0661 fax
CREDIT CARD AUTHORIZATION FORM
INSTRUCTIONS:
Please fill out the form completely, along with:
· A copy of identification (ID, passport) of the credit card holder (Credit card holder has to be from the same country as the applicant.)
· A copy of the credit card, front and back
A 4.5% service fee will apply to all payments made by credit card.
This form should be uploaded in the payment form www.youthassembly.nyc/payment
We accept all major credit cards. Please check what applies to you:Visa MasterCard American Express Discover
Name (As it appears on the card):
Credit Card Number:
Expiration Date: / Security Code: / Zip Code:
I am applying for: Conference Delegate Package
This section only applies to Conference.
I authorize Friendship Ambassadors Foundation to charge:
the application fee of $15 per person plus 4.5% credit card fee on my credit card
the administration fee of $185 per person plus 4.5% credit card fee on my credit card / This section only applies to Delegate Package.
I authorize Friendship Ambassadors Foundation to charge:
the application fee of $15 per person plus 4.5% credit card fee on my credit card
the initial amount of $200 per person plus 4.5% credit card fee on my credit card
the remaining balance amount plus 4.5% credit card fee on my credit card – Please specify amount:
the full amount plus 4.5% credit card fee on my credit card – Please specify amount:
Signature / Printed Name:
Date signed:
*This form has been updated on November 29, 2017.
FRIENDSHIP AMBASSADORS FOUNDATION, INC.
A Not-for-Profit, Tax Exempt 501(c)(3) Organization
Member or Associated: UN DPI • ECOSOC • UNESCO • UNA/USA Council of Organizations • IATAN ·
International Federation of Choral Music · American Choral Directors Association · Greenwich Arts Council