Rugby Team Payments

Forms

Required

Participant's Namerequired

First Name

Last Name

Parent/Guardian Namerequired

First Name

Last Name

Parent/Guardian Emailrequired

Parent/Guardian Phone Numberrequired

Emergency Contactrequired

First Name

Last Name

Emergency Contact Phone Numberrequired

Please choose your payment:required

$500 ($500.00)

$250 ($250.00)

$125 ($125.00)

Emailrequired

Provide an email address for the receipt.

Please select a payment typerequired

Card

Billing Addressrequired

Address

City

State/Province

Country

Zip/Postal Code

Cardholder Namerequired

First

Last

Expirationrequired

Month

Year