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The Arc's Camp by the Sea Online Registration

Summer 2015

Please call Diane Clark at 609-485-0800 ext. 125 or email dclark @arcatlantic.org if you have any questions about your payment.

Camp Payment Form

Payment Amount:

Child's Name:

Contact Information

Company:

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Email:*

Credit Card Information

Card Types Accepted:
Visa

Credit Card Number:*

Card Security Code:*

Expiration Date:*

Electronic Signature:*

I agree to pay above total amount according to card issuer agreement. Once the transaction has completed successfully, a confirmation receipt will be sent to the email address entered.

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