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.]

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: *

Visa
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MasterCard

Credit Card Number: *

(xxxxyyyyzzzzaaaa) no spaces or dashes

Expiration Date: *

(mm/yy)

Card CVV Code: *

3 or 4 digit code

Enter Security Code:

Fan Shop Specials!

$20.00 each Ohio Extreme SC Scarf

$12.00 each T-Shirt

Take advantage of special rates available only to OESC athletes!

Discounts available on both Youth Day Camps and Individual Residential Camps!

Check out the great options and register early to reserve your spot!