Registration Payment Amount*

$

Add 3% to my registration to cover credit card fees.

This payment is:*

Student Registration Payment
Scholarship/Trip Donation

NOTE:

Total

$0.00

Student Information

Student Name*

Student Email*

Your Club*

Parent/Guardian Name*

Parent/Guardian Phone Number*

Parent/Guardian Email*

Billing Information

Name*

Payment Method

Credit Card
Check/ACH
Give cash to CL leader

Credit Card*

Visa
Mastercard
American Express
Discover

Address*

Email*

Phone Number*

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