CTeen Camp Payments - Chabad House Malvern

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CTEEN WINTER CAMP PAYMENT FORM
Camp: Sunday 28th June - Thursday 2nd July

Early bird Cost (until 1st June): $600

Please fill out the payment information below to pay for this years Cteen winter Camp. Please note confirmation of your place in camp is not confirmed until payment is made.
Parent Full Name*
First Name Last Name
E-mail For receipt of payment
Child Full Name*
First Name Last Name
Amount*

$600 AUD
Total

$0.00 AUD

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

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