Floral Image - Dallas Credit Card Form

Registration Payment Form

Please complete this form in order to make payment via credit card
Staff or Camper Name for Payment

First NameLast Name
Registration Amount
Fees for food and lodging
Canteen Amount
Amount for candy and snacks
Donation Amount
Helps kids draw closer to God by experiencing camp
Total Amount

Payment Amount

USDRegistration + Canteen + Donation

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

E-mail
example@example.com
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By signing below I hereby authorize Cascade Friends to charge my credit card for the amount shown above.
Authorization Signature

Clear
SubmissionId
RegistrationType
Should be Empty: