Registration and Membership

2012-2013 Registration and Membership
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2012-2013

First Name:	*
Last Name:	* Girl Boy
Fall Grade: 2012	*
Telephone:	Please give (area code)
Mailing Address:	*
City:	*
Location Desired:	Class Choice
Zip Code:	*Please use format: 99999
School Attending:
E-mail Address:
Payment:
- PAYMENT IS REQUIRED WITH FORM TO COMPLETE REGISTRATION- The registration will be confirmed via email and by mail. CREDIT CARD NUMBER ..............................EXPIRATION DATE VISA Master card AMEX Discover No refunds after thirty days of deposit. A declined credit card will be subject to a $10.00 service fee. A check with non-sufficient funds will be subject to a $25.00 service fee. All participants of the Cotillion must be paid for in full with confirmation by the Gollatz office before attendance. Financial transactions are not conducted at Cotillion events.
If you would like to be a chaperone for the Cotillion, please contact the office with the date you wish to volunteer. (800) 832-4574.
Registration for 2012-2013 (OR) To be added to Mailing List

WE HAVE DIFFICULITES WITH MAC COMPUTER FORMATS. IF USING A MAC COMPUTER, PLEASE SEND YOUR REGISTRATION VIA E-MAIL OR FAX. WE APOLOGIZE FOR THIS INCONVENIENCE.

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