AP Seminars Credit Card Payment 2019
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. We are now in the early registration period (through May 10, 2019). Write total for all checked items in Item #8.
Regular Registration Tuition: $775.00
Lab fee (Biology, Chemistry, Environmental Science, Physics): $30.00
Lodging for Week #1 (7/23-7/26; ComP Sci Principles; breakfast included): $668.00
Lodging for Week #2 (7/29-8/1; breakfast and dinner included): $595.00
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 of checked boxes in item #5 (Double check that this matches the total on your registration summary)
9a. Credit Card Number (Visa, MasterCard, Discover, Am Ex; Format as shown)
VERY IMPORTANT: FORMAT WITH DASHES AS SHOWN Visa, MC, Disc: XXXX–XXXX–XXXX–XXXX; AM EX: XXXX–XXXXXX–XXXXX)
9b. Credit Card Expiration Date
IMPORTANT: FORMAT AS FOLLOWS: MM_YY (not MM/YY)
9c. Credit Card 3-digit Security Code (3-digit code on back)
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