MAKE A PAYMENT ARE YOU REGISTERED WITH A GROUP?*YESNOGROUP NAME*YOUTH PASTOR NAME* First Last REGISTRANT NAME* First Last WOULD YOU LIKE TO REQUEST A FORM WE HAVE CREATED TO HELP YOU KEEP TRACK OF YOUR PAYMENTS?*YESNOHOW MANY PASTORS/SPOUSES ARE YOU PAYING TOWARDS?HOW MANY LEADERS ARE YOU PAYING TOWARDS?HOW MANY CAMPERS ARE YOU PAYING TOWARDS?HOW MANY PASTORS CHILDREN ARE YOU PAYING TOWARDS?PAYMENT AMOUNT* PLEASE NOTE: ALL PAYMENTS MUST BE SUBMITTED BY MAY 22NDCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Total $0.00
