Rally Class Payment Form
Choose below
Name
*
First Name
Last Name
Email
*
example@example.com
Dog's Name (if Multiple Dog's Add Information in Comments below)
*
Choose ONE option below: If you have club vouchers please contact Desma (desmadunne@hotmail.com) to get a coupon code
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Rally Class Non-Member
8 week classes with instructor Samantha Scicchigno
$
215.00
Quantity
1
2
3
4
Item subtotal:
$
0.00
Rally Class Member in Good Standing
8 week class with Instructor Samantha Scicchigno
$
145.00
Quantity
1
2
3
4
Item subtotal:
$
0.00
Rally Class Member TC Discount ONLY
8 week class with Instructor Samantha Scicchigno
$
125.00
Quantity
1
2
3
4
Item subtotal:
$
0.00
Please include Class Time & Session Start date if known
Start Date of Session
*
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Month
-
Day
Year
Date
Class Time (Multiple Classes add information Below
Hour Minutes
AM
PM
AM/PM Option
Comments or Multiple Dog Information
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
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the form.
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