City of George
Public/Private Swimming Lessons
Name
*
First Name
Last Name
Mailing Address
*
Street Address
Post Office Box
City
State
Zip Code
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Do you need bus shuttle from Little Rock for the first session of swimming lessons July 6-17?
*
YES
NO
*
*
*
*
*
Credit Card Information
*
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$40.00 Public Lessons
$41.50
$
41.50
includes processing fees
Quantity
1
2
3
4
5
$65.00 Private Lessons
$67.25
$
67.25
includes processing fees
Quantity
1
2
3
4
5
Total
$0.00
$
0.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
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May
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July
August
September
October
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Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
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2045
Expiration Year
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