SMCHS Girl's Golf Clinic Registration Form

REGISTRATION:

First Name Last Name

Street Address City

State Zip

Phone #

Email Address (*Required Field- Need so I can send confirmation)

PAYMENT METHOD:

Secure Server

American Express Visa Mastercard Discover

Card Holders Name

Credit Card Number Expiration (example- 07/02)

ATTENDANCE:

All 10 weeks- $200.00 Less than 10 weeks-Enter number of weeks below ($20.00 per week)

Number of Weeks: