Paye's Place - Basketball & Volleyball Facility

WNBA Clinic Series (Registration Form)

Dates: 11/1, 11/8, 11/15, 11/26
Cost: $80 per session

Choose the Date you want to attend ( or Dates).

Date

11/1

11/8

11/15

11/26

Information about the player.

DOB

Player Name

ParentName

Address

City

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 10,000 Shot Club. I have committed to the progam. If I decide not to do the program. I must call and cancel 5 days before the first date to get a refund.

Checks are payable to Paye's Place

Thank You,