Join Payment Form Page - Empire Athletics

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PAYMENT FORM

"*" indicates required fields

Name*

First Last

Email*

Phone*

How did you hear about our program?*

How Many Kids Would You Like To Register?*

Participant's Information

Child's Name*

First Last

Child's Date of Birth*

Child's T-Shirt Size*

Participant #2's Information

Child's Name*

First Last

Child's Date of Birth*

Child's T-Shirt Size*

Participant #3's Information

Child's Name*

First Last

Child's Date of Birth*

Child's T-Shirt Size*

Payment Information

How Is The Customer Paying?*

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