SERAK® CAMP REGISTRATION FORM

Registration: Received on or before AUGUST 21, 2008, Camp fee will be ONLY $225.00,  Received AFTER that date, camp fee will be $250.00! So register Early!!

NO PERSONAL CHECKS WILL BE ACCEPTED, NO Exceptions.  Please pay by Credit Card, Money Order, or  Cash -In Person only.

For payment by credit card, please fill out and sign the following:

VISA                              

 

MASTERCARD              

 

DISCOVER                    

 

AMERICAN EXPRESS  

 

Place a check mark next to the type of card at the left and provide your account # and exp. date here: #_______________________________________
exp.date:________

PRINTED NAME AS IT APPEARS ON CARD:
________________________________________
*** SIGNATURE (**required):
________________________________________

Please print your name and street address clearly:

BILLING ADDRESS:                                     DATE:_________________

NAME _____________________________________________________
ADDRESS __________________________________________________
CITY ________________________ STATE _______ ZIP _____________
PHONE(s) ____________________________________________________
EMAIL ADDRESS: ___________________________________________

CIRCLE WHICH CAMP YOU WISH TO ATTEND:    #1-FEB      #2-APR
 

Please print this form and either Fax or mail (with payment) to:
VDT Academy
P.O. Box 1663
Bellflower, CA 90707-1663
FAX #: (562) 920-1827

CLICK HERE TO GO BACK TO CAMP INFORMATION PAGE

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