Pay Weekly Fees Your Name* First Last Phone*Email* Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Are you signing up for a Traditional or School-based Club?Choose OneTraditionalSchool-BasedSelect Traditional Club LocationTraditional Club Location*Select ClubEast DallasCedar SpringsGrand PrairieMesquiteNavarro CountyOak CliffRichardsonRoselandWest Dallas (fmrly Trinity River Mission)Select School-based Club LocationSchool-based Location*Select ClubAnnie Webb Blanton Elementary SchoolBilly Earl Dade Middle SchoolC. F. Carr Elementary SchoolCedar Crest Elementary SchoolDr. Martin Luther King Jr. Arts AcademyEddie Bernice Johnson ElementaryEdward Titche Elementary SchoolElisha M. Pease Elementary SchoolFrederick Douglass Elementary SchoolGeorge W. Truett Elementary SchoolInnovation, Design and Entrepreneurship AcademyJ.J. Rhoads Learning CenterJ.N. Ervin ElementaryKIPP DestinyKIPP Pleasant GroveLincoln High SchoolMadison High SchoolMaple Lawn Elementary SchoolPaul L. Dunbar Learning CenterRufus C. Burleson Elementary SchoolSarah Zumwalt Middle SchoolUmphrey Lee Elementary SchoolUplift Wisdom Boys & Girls ClubWilliam Lipscomb ElementaryWilmer-Hutchins Elementary SchoolClub Member InformationWhat week are you paying for?*Sept. 21-25Sept. 28-Oct. 2Oct. 5-9Oct. 12-16Oct. 19-23Oct. 26-30Number of kids ages 6-12*Number of kids ages 13-18*Child(ren)'s names and ages for who you are paying for*Price* Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Security Code Cardholder Name
