Player Payment Form
Slammers FC - 2008 Camp
Session Information
*
Select which Session you will be attending.
Session Camp July 7-10
9:00 AM to 12:00 PM for Girls
1:00 PM to 4:00 PM for Boys
$100.00
Resident
$399.00
Commuter
*
Payment Method
?
Visa - Online payment
MasterCard - Online payment
Check - Mail in
Program Information
How did you hear about our program
?
School Brochure
Mail Brochure
Other Brochure
Display Banner
Verbal Referal
Newspaper Ad
Web Site
Other
Referring Persons Name
Payment Information
*
Do not enter spaces or hyphens for the credit card number
*
Enter credit card holders name exactly as it is on the credit card
*
Credit Card Number
*
Expiration Date
Month
Year
?
01 - January
02 - February
03 - March
04 - April
05 - May
06 - June
07 - July
08 - August
09 - September
10 - October
11 - November
12 - December
?
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
*
First Name
Middle Initial
*
Last Name
*
Enter credit card billing address and phone number
*
Email address is for transaction confirmation
*
Address
*
City/Town
*
State
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Wyoming
*
Zip code
*
Phone
Area Code
Local Number
(
)
-
*
Email
By selecting the
Continue
button below you are giving authorization
for your credit card to be charged the
Registration Fee
amount indicated above