AP Seminars Credit Card Payment
Submission of this form does NOT immediately charge your card. That will be done manually by AP Seminars once this form is received. Your payment will be confirmed by e-mail.
1. LAST Name of Participant
2. FIRST Name of Participant
3. Primary Phone (FORMAT, PLEASE: XXX-XXX-XXXX)
4. Primary e-mail
Subject registered for
Computer Science Principles
Computer Science A
Government and Polictics-US
5. What is it you want to pay for?
Check all that apply. Regular registration period ends June 29 .
Regular Registration Tuition: $785.00
Lab fee (Biology, Chemistry, Environmental Science, Physics): $30.00
Lodging for Week #1 (7/24-7/27; ComP Sci Principles): $640.00 (FULL)
Lodging for Week #2: $550.00 (7/30-8/2): $550.00
Four Day Lunch Plan: $65.00
Other-explain in #7
6. If buying lunch, do you have any dietary restrictions?
Use only if you chose "Lunch" in #5
7. Explanation of "Other" from item #5
Please be as specific as possible
8. . What dollar payment is being made with this form?
Total checked boxes in item #5 (Double check that this matches the total on your registration summary)
9. Credit Card Number (Visa, MasterCard, Discover, Am Ex)
VERY IMPORTANT: FORMAT WITH DASHES AS SHOWN Visa, MC, Disc: XXXX–XXXX–XXXX–XXXX; AM EX: XXXX–XXXXXX–XXXXX)
10. Credit card Expiration Date
IMPORTANT: FORMAT AS FOLLOWS: MM_YY (not MM/YY)
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service