Event Reservation Form

Contact Information

Title

First Name

Last Name

Address

City

State

Zip

Phone

Tuition Details

$100 Registration and $180 Security fees are due now. Tuition is divided into 9 equal payments. 1st payment will be charged today, and then automatically charged on the 1st of each month ending on May 1st, 2023. When choosing "QTY" choose 1 unless you would like to make more payments up front.

Tuition Options	Qty	Amount
HS Registration		100.00
HS Security		180.00
HS Tuition full payment		1400.00
HS Tuition 1st of 9 payments		156.00
HS Tuition 1st of 8 payments		175.00
DJCC Members full tuition -10%		1260.00
DJCC Members HS tuition 1st of 9 payments		140.00
DJCC Members HS tuition 1st of 8 payments		158.00
BMC Registration		100.00
BMC Security		180.00
BMC Tuition full payment		1400.00
BMC Tuition 1st of 9 payments		156.00
BMC Tuition 1st of 8 payments		175.00
DJCCMembers BMC full tuition-10%		1260.00
DJCC Members BMC tuition 1st of 9 payments		140.00
DJCC Members BMC tuition 1st of 8 payments		158.00
Total

Child Name

Payment Information

Total Amount

Card Number

Card Expiration

Security Code

Same as above

Name on Card

Billing Address

Zip Code