2017 BAXTER JACK'S MEN'S SUMMER LEAGUE PAYMENT FORM
Summer League Fees Due June 22nd, 2017.
  * Required Fields
CAPTAIN'S NAME: *
YOUR NAME(if not Capt):
TEAM NAME: *
ADDRESS: *
CITY: *
STATE: *
ZIPCODE: *
WORK PHONE:
HOME PHONE:
EMAIL: *
   
SELECT A DIVISION:
DIVISION NAME: Men's B / B+ Ct 2
DIVISION CODE: Mon
DAY: Monday
   
OPTIONS: Summer Payment With Paid Deposit ($250.00)
Summer Payment ($300.00)
TOTAL: $300.00
   
PAYMENT TYPE: Credit Card 
PAYMENT INFO:
Name On Card:
Credit Card Number:
Credit Card Type:
Expiration Date:
CVV Code:
Summer League Fees Due June 22nd, 2017.