Adult Payment

On-line Payment for the Pass Academy

Use this form to make a payment for an adult clinic or lesson.

Adult Payment Form
Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Email Address*
Enter Email Confirm Email
Phone*
Private Lesson
Private Lesson Amount Quantity
Price: $1.00
Enter the dollar amount and press the Enter key
Pro's Name
Gratuity Quantity
Price: $1.00
Enter optional dollar amount for pro.
Clinic Amount
Clinic Dollar Amount Quantity
Price: $1.00
Enter the dollar amount and press the Enter key
Total Payment
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Additional Information (optional)