Banquet Payments 

If you pay by credit card, print next page and keep it for your records, if you would like to. 

Complete the Payment information below,  You are now on a secure server.
First Name Card *required
Last Name Card *required
Address *required
City *required
State *required
 Zip  *required
 Phone #  *required

E-mail Address

 *required
Players Name *required

 Level of Play 

not required for donations or other payments
Payment for? *required
I will be Paying by *required
Card # *required
3-Digit Verification  (This is on the back of the card, the last 3 #'s) *required
Expiration Month/Year *required
Automatic Payment Plan  

# Attending (Participant $12/Child $16/Adult $20)

 *required


By Submitting this form you agree to the payment you specified.  You also acknowledge that if this is for the 2012 banquet

Privacy Statement - All personal information provided to us will remain private and confidential and not be sold to anyone without your express written permission