Guardian Senior Retreat Payment Form

Purchaser's Name *

First

Last

Please provide your name in the Purchaser's Name field. This allows us to keep track of your order and ensure smooth communication regarding your purchase.

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Billing Phone *

Please provide your billing phone number in the Billing Phone field. Rest assured, we will only use this information if there is a problem with your order and need to contact you for resolution.

Dancer's Name *

First

Last

Please include the name of the Guardian you're purchasing for in the Dancer's Name field.

Payment Options: *

Balance Due (for those that previously paid the $35 deposit) - $ 118.45
Pay in Full $150 - $ 154.50

Choose the option that works best for you. Prices include the credit card convenience fee.

Total

$ 0.00

Square *

Card

Name on Card

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