Event widget with payment

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08/19/2023 - 08/19/2023

3400 Radio Rd

$ 50

First Name *

Last Name *

Email *

Phone *

Date of Birth *

Gender *

Male

Female

State *

City *

County *

ZIP Code *

Residential Address *

Event Date
Event Start Time - Event End Time

Name on Card *

Card Number *

Expiration *

CVC *

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