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MAS - Community and Youth Center

3155 Dwight Road, Elk Grove, California 95758, USA

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MQI Summer Camp First Session (June 10th-July 4th)

21
JUN

10:00 AM

19
JUL

1:00 PM

Program Fee:

One Time: $175.00

Offering Days: Monday, Tuesday, Wednesday, Thursday

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Reserved Seats: 56/100

1 Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

Address1 *

Address2

Country *

State *

City *

Zip Code *

Cell Number

2 Add Registrants

Primary Contact as First Registrant

Registrant Name*

Email Address

Age

Gender

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3 Payment

You can help save us on credit card transaction fees by selecting the eCheck/ACH option. Jazak'Allah!

Payment Method

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Credit/Debit Card

Name on Credit Card *

Credit Card Number*

Expiry Date*

CVV Code*

Bank Name

Name on Account *

Account Number*

Routing Number*

Account Type*

Monthly Recurring

Recurring Start Date*

Number of Months*

For Lifetime

Please note: You will incur a $1 charge if the recurring start date is not current date in order to verify the payment details provided. This charge will not be credited back to your account and you will receive a test transaction receipt for this amount.

Consent * Do you give MAS - Community and Youth Center consent to authorize electronic fund transfer from the account specified for this transaction in the amount specified.

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MAS - Community and Youth Center

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MQI Summer Camp First Session (June 10th-July 4th)

1 Contact Information

2 Add Registrants

3 Payment

Payment Summary

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