Registration Fee Payment Center 2016-2017

NOTE: For monthly fees, please do not use this form. Instead, please fill out the Credit Card Authorization Form by clicking here or you can pay by check or cash at the main club.

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. Registration Fees are $80 per child.

If paying for multiple children, you can combine your payment into one and list the member names in the spaces provided or in the comments section. For example, if paying for two children, please make a payment of $160.

Please contact our Membership Department at (818) 842-9333 x113 or priscillagalvan@bgcburbank.org with any questions.

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

* First Name

* Last Name

* Member Name

Member Name 2

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: $5.00)

* Email to receive receipt:

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