To Pay by Visa or Master Card only:

Please click on the arrow to select the card type: 

Last 4 digits of your credit card number   Expiration date (MM/YY)

Name as it appears on your credit card

Billing address, city, state, zip:

Amount of payment:

Please fax or call in the credit card name and the credit card number:
Fax: 510-217-2312
Voice Mail: 734-735-8162

Registration Form:
Please fill in the following information, as it should appear on your receipt, for each person that is registering.

First and Last Name

Mailing address, city, state, zip:

E-mail address  Phone 

If staying at the Riviera Hotel please enter your Hotel Registration Number

Please click on the arrow to select the event you are registering for


First and Last Name

Mailing address, city, state, zip:

E-mail address  Phone 

If staying at the Riviera Hotel please enter your Hotel Registration Number

Please click on the arrow to select the event you are registering for


First and Last Name

Mailing address, city, state, zip:

E-mail address  Phone 

If staying at the Riviera Hotel please enter your Hotel Registration Number

Please click on the arrow to select the event you are registering for


First and Last Name

Mailing address, city, state, zip:

E-mail address  Phone 

If staying at the Riviera Hotel please enter your Hotel Registration Number

Please click on the arrow to select the event you are registering for

This is NOT a secure server, if you are uncomfortable sending this information over the internet, please print this page and mail or fax to below listed information.

Please review the information you've entered for accuracy, then click  to send.

Payment questions:
Email: JodyCantwell@hotmail.com

Mail: Cher Convention 2004, 5410 S. Custer Rd., Monroe, MI  48161
Fax: 510-217-2312
Voice Mail: 734-735-8162

Click to clear form.

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