Quantum Leap: High School Edition starting 06/22/2019

Registrant Info

First name

Last name

E-mail

Confirm E-mail

Phone Number

Year of birth

Keller Williams Affiliation

Because of our generous donors, KW Next Gen events are always free to young adults under 30. Registrants 30 and above are encouraged to pay it forward with a donation so we can continue to offer free programming, coaching and scholarships to the next generation.

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Donation Amount

I'd like to cover the transaction fees of $0.00 for a total of $0.00 for my donation.

Amount

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Donor Info

KW Affiliation

I am not affiliated with Keller Williams

KWUID

Donor info the same as registrant info.

First Name

Last Name

E-mail

Confirm E-mail

Phone Number

Address

Address 2

Country

State

City

Zip Code

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Payment Info

Name on card the same as donor name

Name on Card (first)

Name on Card (last)

Credit Card #

CVC

Zip Code

Exp. Month

Exp. Year

Verification

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KW Next Gen does not accept restricted gifts. KW Next Gen donations are directed to areas of greatest need, enabling us to provide learning experiences, coaching, and scholarships that empower the next generation to pursue their personal mission and make an impact in their communities.