Important Dates

June 5-6 - 2012/2013 Competitive Team Tryouts - All Age Groups

Please use this form to make your player fee payment by Credit Card. You may also mail your payment to: Ohio Extreme SC 4565 Elida Rd. Elida, OH 45807

( * = required field )
First Name:  *  
Last Name:  *  
Address:  *  
City:  *  
State:  *  
Zip Code:  *  
Email:  *  
Confirm Email:  *  

Amount ($):  *  
$175.00   Deposit  [ Deposit for Player Fees ] 
   [You may insert your donation amount here instead of using one of the above amounts.]
Payment Frequency:  *  
Start Date:  *   calendar
No. of Donations:  *  

ADDITIONAL INFORMATION
Player First Name:   * 
Player Last Name:   * 
What is this payment for? (Please check all that apply):   *    Player Fees    Uniform Fees    Fan Shop    Brandon Gillen Lymphoma Support Fund  
Comments:

PAYMENT INFORMATION
Please select the credit card type:
Credit Card Type:  *  


Credit Card Number:  *  
(xxxxyyyyzzzzaaaa) no spaces or dashes
Expiration Date:  *     (mm/yy)
Card CVV Code:  *   3 or 4 digit code
Enter Security Code:

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