Payment Center 14-15

Thank you for making a payment for your child to attend Boys & Girls Club of Burbank and Greater East Valley.

Please fill out the form below to make your registration payment of $75. If paying for multiple children, you can combine your payment into one and just state who the members are in the comments section. For example, if paying for two children, please make a payment of $150 and include both children's names in the comment box.

For monthly payments, please fill out a Credit Card Authorization Form by clicking on the below link.

https://docs.google.com/forms/d/1nyYVDu0cXPM3fSKxXLujIiZKrS_gQmq5prnTpAH2DxQ/viewform

Please contact our Membership Director at (818) 842-9333 x13 or LuisaGomez@bgcburbank.org with any questions.

Please fill out the form information below ( * = required fields)

* First Name

* Last Name

* Member Name

Site Location (to select multiple sites, use the control key)

Day Time Phone

Comments

* First Name on Card

* Last Name on Card

* Billing Address

* Billing City

* Billing State

* Billing Zip

* Card Type

* Credit Card Number

* Expiration Date

* CCV

* Amount: (ex: 10000.00)
(minimum: $1.00)

* Email to receive receipt:

Check the box below to verify that you are not a robot: