Elks Camp Grassick Campership Fee Credit Card Payment Form
Camper's Name
*
First Name
Last Name
Additional Campers
Parent/Guardian/Party Responsible for Payment
*
First Name
Last Name
My Products
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3 Week Camp
Full 3 Week Campership Fee
$
700.00
Quantity
1
2
3
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5
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10
2 Week Camp
Full 2 Week Campership Fee
$
500.00
Quantity
1
2
3
4
5
6
7
8
9
10
Companion Camp Camper Fee
$
300.00
Quantity
1
2
3
4
5
6
7
8
9
10
Companion Camp Companion Fee
$
100.00
Quantity
1
2
3
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5
6
7
8
9
10
Adult Camp
$
150.00
Quantity
1
2
3
4
5
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7
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10
Partial Payment
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Email for Receipt
example@example.com
Submit
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