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		1200.00
HS Tuition 9 Payments		134.00
HS Tuition 8 Payments		150.00
DJCC Members HS Tuition Full Payment		1080.00
DJCC Members HS Tuition 9 Payments		120.00
DJCC Members HS Tuition 8 Payments		135.00
BMC Registration		100.00
BMC Security		180.00
BMC Tuition Full Payment		1200.00
BMC Tuition 9 Payments		134.00
BMC Tuition 8 Payments		150.00
Total

Child Name

Payment Information

Total Amount

Card Number

Card Expiration

Security Code

Same as above

Name on Card

Billing Address

Zip Code