Youth Payment Form 2 Name of Student(required) Email Address(required) Home Phone Number Mobile Phone Number What are you paying for? Please select one Green Fleet/BeginnersOptimist White Fleet/IntermediateOptimist AdvanceLaser ClassPrivate LessonsChristmas CampOther PAYMENT Card type - please select VISAMastercard Name of Cardholder Card Number Expiry Date - mm/yy Card Security Code (3 digit number on the back) Amount of Payment (US$) An Electronic Receipt will be emailed to you when processed. Δ