Lansing Youth for Christ

Thank you for choosing to attend a Campus Life trip!

TRIP & MERCHANDISE OPTIONS AND PAYMENT AMOUNTS

Please select which trip(s) or merchandise you are paying for and enter the total amount in the Payment Amount box below.

Students will need to tell their club director which color(s) they would like for their merchandise.

Montana

Mask - $6

T-Shirt - $10

PLEASE ENTER YOUR PAYMENT AMOUNT BELOW

Payment Amount

Student Information

Student Name: *

Student's School: *

Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

E-mail: *

A receipt will be e-mailed to this address.

Your Payment Information

Name on Card:

Card Number:

Security Code:

Expiration Date:

Name on Account:

Routing Number:

Account Number: