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PAYE'S PLACE Pick Up Basketball Registration Form

$99 - Club Member Fee
$125 - Non-Club Member Fee

Information about the player.
DOB
Player Name
ParentName
Address
City
St
Zip

How do we Communicate with you?
Home Phone:
Email:
CellPhone:

Pay By:    Check    Credit Card    *Payments

Credit Card Information
*Fill this section out below if you clicked to pay by credit card, otherwise just click I accept.
Credit Card Type
Credit Card Number
Expires
Card Security Code
Name
Street
City
State
Zip
 




I understand that I have signed up for the Paye's Place Pick Up Basketball for the Spring/Summer.

Checks are payable to Paye's Place

Thank You,




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