2019 ICON Payment Page First Name: Last Name: Street Address: City: State: Zip: E- mail:Telephone: REGISTRATION TYPE QUAD: $695 – TRIPLE: $795 – DOUBLE: $1,095 – SINGLE: $1,700: ~To enter another amount, select other and click continue below The actual cost includes a 2.9% + $.03 transaction fee, and will be slightly higher than the selected price If paying after the deadline, there will be a late fee of $25 SELECT 1: Quad $695Triple $795Double $1095Single: $1,700Secretary/Treasurer Quad: $295Board Member Quad: $495Other (enter amount in next page) Include any pertinent detail about your registration here. _ _