LIFELINE TEAM FEES PAYMENT FORM

PAYMENT AMOUNT*

USDPayment Amount

Credit Card

Apple Pay

Google Pay

Cash App Pay

Participant*

First NameLast Name
Parent/Guardian*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
PAYMENT CONFIRMATION

Please review your selections and payment amount prior to submitting payment. All credit or debit card payments must be submitted by the card holder or authorized user on the account linked to the card. Program fees are non-refundable. Payments for apparel may be refunded if order is canceled within 48 hours of when the order was placed. To cancel or modify your order, please call 470-470-4881.
I have read and agree to the terms and conditions related to my payment
Time*

:HourMinutesAM/PM Option
Should be Empty:

LIFELINE PAYMENT FORM