Authorize Payment Form
To pay online, please enter the information in the fields below.
Dancer's Name
*
Dancer's Class
Example: Monday Ballet/Tap
Email
*
example@example.com
Payment
*
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( X )
USD
ex: $39
Card Number
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
Signature
*
By signing this, you authorize the payment of the amount indicated.
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