Registration | Gollatz Cotillion & Social Programs For Children

Gollatz Cotillion Registration 2023-2024

1st Child's First and Last Name * Please indicate girl or boy after name:

2nd Child's First and Last Name. Please indicate girl or boy after name.

Grade ( Fall) - School Attending

2nd Child - Grade (Fall) - School Attending

Home Address

City and Zip Code

Phone

Location

Payment

Partial Payments of $150.00 for deposit accepted until 7/1/23

Pasadena Cotillion at the La Canada Country Club $398.00

Orange Woman's Club $378.00

Tustin Ranch Golf Club $475.00

Pay by check (no additional fee) mail the Cotillion response and check to: The Gollatz Cotillion, 18500 Arrowhead Blvd. Devore Heights,CA. 92407 Gollatz Cotillion 18500 Arrowhead Blvd. Devore Heights

Thousand Oaks / Camarillo $398.00

Name on Credit Card

Credit Card

CVV Code - on back of card

Expiration Date of credit card

If paying by credit card a $10.00 credit card service fee will be added the the membership

Optional - I would be interested in chaperoning a Cotillion event - Please choose a date:__________________________

I give my consent for my child to attend

Thank you for submitting your registration application to the Gollatz Cotillion. Once processed, an email from the Gollatz business office will be sent to you to confirm your child's membership

Quality ~ Legacy
(909) 880-8654

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