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Boys' Life Skills Workshop 2016 Subscription

Please fill out the form below to register for Boys' Life Skills Workshop 2016. The price you have to pay is $30.00.

First Name *

Last Name *

Organization

Address *

Address2

City *

Zip *

State *

Phone *

Email *

What school does the player attend?

What grade is the player in?

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone Number *

Emergency Contact Email Address *

Price

Discount Amount

Gross Amount

Coupon

Payment Method

Paypal

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

Bank ABA Routing Number*

Bank Account Number*

Bank Account Type*

Bank Name*

Account Holder Name*

I accept Informed Consent, Release and Waiver of Liability