I authorize NWSRA to bill directly to my: Please check one: Amex Visa MasterCard Discover Please Print Clearly Name as it appears on the credit card: E‐mail Address: Card Number: Expiration Date: Automatic Bill Payment Schedule To be completed by Office Staff: Funds will be debited according to the following schedule: Season 1/3 of amount debited Second 1/3 of amount debited Winter/Spring Day Camp Summer Fall Registration Deadline February 1 Registration Deadline July 1 Registration Deadline July 1 Registration Deadline October 1 Final 1/3 of amount debited March 1 August 1 August 1 November 1 To be completed by registrant: I authorize NWSRA to automatically withdraw payments in the amount shown from the listed account on the dates provided above..
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