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Vanguard Initiative JOAD
Registration Form
Participant(s)
*
Any medical conditions, disabilities, or special accomodations? (type n/a if appropriate)
*
Parent/Guardian Information
Parent/Guardian 1 name
*
First Name
Last Name
Primary E-Mail (Note: this is the email account that will receive invoices)
*
example@example.com
Parent/Guardian 1 Phone Number
*
-
Area Code
Phone Number
Parent/Guardian 2 Name
First Name
Last Name
Parent/Guardian 2 E-mail
example@example.com
Parent/Guardian 2 Phone Number
-
Area Code
Phone Number
Membership Options
Membership Options (Billing begins 30 days after registration - You have the option to cancel at any time)
*
prev
next
( X )
Individual Youth
(Free for the first
30 Days
then,
$
40.00
for each
month
)
2 youth (18% discount)
(Free for the first
30 Days
then,
$
65.00
for each
month
)
3 youth (25% discount)
(Free for the first
30 Days
then,
$
90.00
for each
month
)
4 youth (31% discount)
(Free for the first
30 Days
then,
$
110.00
for each
month
)
Total
$
0.00
Terms of Conditions & Signature
Print Name
*
Signature
*
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