2019 THOR West - Team Registration - Credit Card

Team Number

Team Name

Your First Name

Your Last Name

Phone

Team Registration

Please coordinate with all team leaders and members and submit ONE registration per team. Registration is first-come, first-serve with your spot fully reserved upon payment in full.

Please select your registration choice:

Regular Registration - Payment in full due by August 30 + $400.00
Regular Registration - Deposit + $50.00
2nd Year Team - Rookie in 2019 + $175.00
Pre-Rookie Team - planning to be a rookie team in 2020 + $5.00

Billing Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Sub Total

$0.00

TOTAL

$0.00

Payment Method

Credit Card

Credit Card Type

Select

Name on Card

Credit Card Number

Expiration Date

Month

Year

Verification Number

Signature

To accept this registration, type your name below

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