University of Toledo Soccer Camp

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Registration
*Designates a required field

*Name:
*Home Address:
*City:
*State:
*Postal Code:
*Home Phone:
Business Phone:
E-Mail:
*Birthdate:
*Grade in Fall 2013:

Please select the camp your child will be attending:

T-Shirt Size:

Discounts:

	Camp alumni subtract $5 from each application.
	Second sibling receives $10 off.
	Pay before May 10th and subtract $5 from each application

*Special rates for children of UT faculty/staff available, but not online. Please see faculty/staff flyer for details.

Choose a Payment Option:
(Please note $5.00 Surcharge added for Credit Card Registration)

Credit Card Type:

	Visa
	MasterCard

Amount:
Card Number:
Expiration Date:	/
Name as it appears on Card:

Alternate Payment Option - Please submit form and payment to: The University of Toledo - Soccer
2801 West Bancroft Street, MS 408
Toledo, Ohio 43606-3390

Last Modified: May 16,2011

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