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Chidlow Sandi Simons 2-day performance Clinic
Clinics & Camps
Clinic Registration
Step 1 of 3 - Information
33%
Clinic Registration
Price:
$ 0.00
Clinic Registration
Price:
$ 100.00
Registration Type
Participant
Fencesitting
Number of Days
1 Day
2 Days
Dates Attending
Please provide the dates you will be attending
Day 1 Attending
*
Date Format: DD dash MM dash YYYY
Day 2 Attending
*
Date Format: DD dash MM dash YYYY
Day 3 Attending
*
Date Format: DD dash MM dash YYYY
Day 4 Attending
*
Date Format: DD dash MM dash YYYY
Name
First
Last
Email
Phone
How much will you be paying today?
FULL AMOUNT
50% DEPOSIT
MINIMUM DEPOSIT (NON-REFUNDABLE)
Amount Paid Today
remaining balance due 2 weeks prior to the event date
Amount Paid Today
remaining balance due 2 weeks prior to the event date
Credit Card
*
American Express
Discover
MasterCard
Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
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2039
2040
Expiration Date
Security Code
Cardholder Name
Comments
This field is for validation purposes and should be left unchanged.
Clinic Details
Start Date
17 Apr, 2021
End Date
18 Apr, 2021
AU State
WA
Full Cost
$500
Fence Sitting
$132
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