CCM Selects - Payment (Girls) CCM Selects - PAYMENT (Girls) PAYMENT PROCESSINGTOURNAMENTS Apr 19-21, 2019 STX Chi-Town Shuffle 12U, 14U, 16U TRAINING CAMPS May 3-5, 2019 College Training - Notre Dame 10U, 12U, 14U, 16U TOURNAMENT CAMP SELECTIONSTX Chi-Town Shuffle (if selected)April 19-21, 2019 $200 Chi-Town College Training - Notre DameMay 3-5, 2019 $425 Notre Dame Jersey & Socks (Tournament Teams Only)2 jerseys, 1 pair of Socks $66 Jersey & Socks PLAYER INFORMATIONPlayer Last Name*Player First Name*Birth Date* PARENT/GUARDIAN INFORMATIONFirst Name*Last Name*Email* Phone*Additional InformationNOTE: A 4% Service Charge will be added for all Credit Card TransactionsPayment Type*Pay By Credit CardPay By CheckALL PAYMENTS ARE (USD)Credit Card Payment Amount (USD) Price: $0.00 NOTE: A 4% Service Charge was added for Credit Card Transaction.Check Payment Amount (USD) Price: $0.00 You will receive "PAYMENT BY CHECK" instuctions once you submit this payment information.Credit Card MasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Refund Policy*REFUND POLICY Refund Policy Full refund ( minus the 4% handling fee if paid by cc) will be issued up to 45 days of selected camps/tournament. I have read and understand the Refund Policy This iframe contains the logic required to handle Ajax powered Gravity Forms. Click here to Print Payment Form
