Maine Golf and Tennis Academy

Please call with any questions (207) 465-3226

Camper Name First Last
Nickname?
Birthdate / MM / DD YYYY
School
Grade completed by the current camp year
Age on July first of the current camp year
Gender Male Female
BILLING INFORMATION
Name First Last
Billing Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Email
Phone - (###) - ### ####
Payment Method - Please contact us for information about wiring payments
Credit Card Number (xxxx-xxxx-xxxx-xxxx)
CSV (Security Code found on back of Card)
Expiration Date (mm/yyyy)
Name on Card
Amount of Payment Deposit all sessions: $2,000 Deposit mini-session/family camp $1,500 $ . Dollars Cents