WSO Water Polo Trip Payment

Instructions

• Enter all billing information for the parent/guardian who will be making the payment.
• Enter players First Name, Middle Initial, Last Name and Birthdate
• If you have more than one player you must fill out additional forms
• When you are finished entering information click on the Green Submit button.
• Cost is $1200. You must be a member of USA Water Polo.

Billing Information

Amount $

First Name

Last Name

Address

City

State

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

Email

Phone

Player

First Name

Middle Initial

Last Name

Birthdate

Yr in School

5 6 7 8 9 10 11 12

Gender Male Female