Name: {Name (First):1.3} {Name (Last):1.6}
Address: {Address (Street Address):3.1} {Address (Address Line 2):3.2}
City: {Address (City):3.3}
State/Province:{Address (State / Province):3.4}
Postal Code: {Address (ZIP / Postal Code):3.5}
Country: {Address (Country):3.6}
Contact Phone: {Phone:4}
Email: {Email:5}
STEM Workshop Requested: {Field:83}
Date requested: {Field ID:85}
Number of participants you are paying for: {Field ID:84}
Total Amount: {Total:20}