2009 Lehigh Valley Wrestling Daycamp Payment Form July 27th-July 31st 2009
Date
Name of Wrestler
Wrestler Info
Age: Weight: Years Experience Team:
Address
Street: City: State: Zip Code:
E-mail Address
Phone #
Home #: Cell #:
Camp Session (s): Week 1, Week 2 or Both Weeks
Camp Photo (8x10) $10 Photo will be sent a few weeks after camp
Specify quantity:
Free T-Shirt Size
(YS 6/8, YM 10/12, YL 14/16, AS, AM, AL, AXL)
Extra T-Shirt Order ($15.00 ea.)
Size:
YS
YM
YL
AS
AM
AL
AXL
Qty.
Cost of Camp Photo and Extra T-Shirts will be added to your camp payment
Payment Type
Check
Money Order
Purchase Order*
Gift Certificate
MasterCard
Visa
Amex
Discover
* - Purchase order must be paid with in 30 days Also, please enter purchase order or gift certificate # here:
Credit Card number
exp:
Full Name of Card Holder
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