CLINIC REGISTRATION
Complete the following form and bring or send with payment to Paintball Arena, 400 Patton Ave, West Babylon, NY 11704.
TEAM NAME
CARD TYPE
MONTH
YEAR
CARD HOLDER'S INFORMATION
PAYMENT
IF YOU NEED TO START OVER OR YOU'VE FINISHED PRINTING OUT THE FORM, CLICK THE RESET BUTTON TO CLEAR. WE DO NOT FEEL SECURE ABOUT RECEIVING YOUR CREDIT CARD INFO VIA EMAIL ON OUR CURRENT SYSTEM; ALL REGISTRATION FORMS MUST BE SUBITTED THE "OLD FASHIONED WAY." THANKS!
ALL INFORMATION CORRECT? PRINT IT!
WHICH CLINIC ARE YOU SIGNING UP FOR?
PLEASE COMPLETE ALL INFORMATION:
CREDIT CARD INFORMATION
PAYMENT METHOD
NAME
ADRESS
TOWN
STATE
ZIP CODE
EMAIL
CARD NUMBER
NAME
ADDRESS
TOWN
STATE
ZIP CODE
PHONE
DATE OF REGISTRATION
YOUR EXPERIENCE LEVEL
