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Request for Online Registration, Payments and Insurance
MBX asks for one week lead time to process online payment requests. Please email Kathy Duffy at
kathy@mbxfoundation.org
with questions.
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* Indicates required question
Email
*
Your email
Today's Date
*
MM
/
DD
/
YYYY
Has your camp or activity and the location been approved by Mike Rosenthal?
*
Yes
No
Your Organization
*
Your answer
Contact Person
*
Your answer
Contact Person Email
*
Your answer
This payment is for:
*
A children's camp registration (requires a waiver)
A payment for a participatory event (requiring a waiver)
A payment for travel (requiring a waiver)
An item, such as T-shirt, or swag
A ticket for an event (not requiring a waiver)
A payment for travel (not requiring a waiver)
Other:
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