Lansing Youth for Christ

Thank you for choosing to attend a Campus Life trip!

TRIP OPTIONS AND PAYMENT AMOUNTS

CORE Retreat - $25

Cedar Point - Oct 26 - $60

Niagara Falls - Nov 26 - $20

All Night Party - Dec 6 - $25

Ski Trip (Rental Equipment) - Jan 2 - $70

Ski Trip (Personal Equipment) - Jan 2 - $50

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: