Sandwich Park District

Celebrating 41 Years of Service to the Community On-Line Registration Form

Home Up Programs & Trips Sports Facilities & Parks Administration Links

 

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bulletPlease provide the following contact information:
Name
   
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
E-mail
bulletChoose one of the following options:


bulletPlease identify and describe the 1st Participant:
Name
Date of Birth
Sex Male Female
bulletPlease provide the following program information:

Program Name 1: 

Program Number
Program Cost
bulletPlease provide the following program information:
Program Name 2
Program Number
Program Cost
bulletPlease identify and describe a 2nd Participant:
Name
Date of Birth
Sex Male Female
bulletPlease provide the following product information:
Program Name 1
Program Number
Program Cost
bulletPlease provide the following product information:
Program Name 2
Program Number
Program Cost
bulletChoose one of the following options:


bulletEnter your credit card number in the space provided below.


bulletEnter your expiration date in the space provided below.


bulletIf you are using VISA please enter your "V" code in the space provided below. (the last three numbers on the back of your card)


bulletEnter the name that appears on the credit card in the space provided below.


 

Send mail to sandwichparkdistrict@comcast.net with questions or comments about this web site.
Copyright © 2007 Sandwich Park District
Last modified: 03/19/08