Weekly Fee Payment Form - Summer '20 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 Club Location*Select ClubEast DallasGrand PrairieMesquiteNavarroOak CliffRichardsonWest Dallas (fmrly Trinity River Mission)What week are you paying for?*June 29-July 2 (Closed July 3)July 6-10July 13-17July 20-24July 27-31August 3-7August 10-14August 17-21August 24-28Number 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
