AP Seminars Credit Card Payment 2021
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 (personal, not school)
Subject registered for
Art and Design
Computer Science Principles
Computer Science A
Government and Polictics-US
5. What is it you want to pay for?
Check all that apply. We are now in the Early Bird Registration Period. Write total for all checked items in Item #8.
Registration Fee (on/after June 1): $650.00
Lab Fee (Art & Design, Biology, Chemistry, Environmental Science): 30.00
Palo Alto HS Teacher: $100
Non-USA Shipping (optional): $100.00
6. Explanation of "Other" from item #5
Please be as specific as possible
7. What dollar payment is being made with this form?
Total of checked boxes in item #5 (Double check that this matches the total on your registration summary)
8a. Credit Card Number (Visa, MasterCard, Discover, Am Ex; FORMAT WITH DASHES AS SHOWN BELOW)
VERY IMPORTANT: FORMAT WITH DASHES AS SHOWN Visa, MC, Disc: XXXX–XXXX–XXXX–XXXX; AM EX: XXXX–XXXXXX–XXXXX (not XXXXXXXXXXXXXXXX)
8b. Credit Card Expiration Date
IMPORTANT: FORMAT AS FOLLOWS: MM_YY (not MM/YY)
8c. Credit Card 3 or 4-digit Security Code (code on back of card)
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