Obedience Monday Class Payment Form
This form is ONLY to be used by those students currently taking classes with Regina at SICDTC or have been pre-approved by the registrar
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Include Start Date of Session & Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Dog's Name (for Multiple dogs add information in comments below)
*
Comments or If more than one dog add here
Obedience Classes: If you have club vouchers please contact Desma (sicdtc@hotmail.com) to get a coupon code
*
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Monday Obedience Class Non-Member
8 week classes with instructor Regina Steiner
$
215.00
Quantity
1
2
3
Item subtotal:
$
0.00
Monday Obedience Class Member in Good Standing
8 week class with Instructor Regina Steiner
$
145.00
Quantity
1
2
3
Item subtotal:
$
0.00
Monday Obedience Class Member TC Discount ONLY
8 week class with Instructor Regina Steiner
$
125.00
Quantity
1
2
3
Item subtotal:
$
0.00
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
submit
the form.
Submit
Should be Empty: