Payment Adjustment Form
Please complete this form if you wish to upgrade your membership or are have been requested to make a payment adjustment.
Contact Information
Please provide details of the contact person for this registration. ie parent/guardian
Contact Name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Mobile
*
Please enter a valid phone number.
Format: 0000000000.
Member details
Member Name
*
First Name
Last Name
DOB
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Upgrade Type
*
Please Select
from Aussie Skate to ISA TESTING
from Aussie Skate to ACTIVE SKATER
from ISA Testing to ACTIVE SKATER
from Judges, Officials & Coaches to ISA TESTING
from Judges, Officials & Coaches to ACTIVE SKATER
Total Payment $
Square Processing Fee $
Total Payment $
Payment
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AUD
Category Amount
Credit Card
Submit
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