Note: Before completing your
online application, please print the following forms listed below.
Participants will need to complete forms and forward to our Council
Office at the address below as soon as possible:
Sea Kayak Program -
Coastal Empire Council, Inc. - 11900 -Abercorn Street - Savannah, Georgia
31420
Your Name:
Address 1:
Address 2:
City:
,
State:
Zip:
Home Phone:
Other Phone:
Email Address:
Register Unit Members As Participants (Max. 14 seats)
Make An Additional Payment
Unit #
Council Name:
HQ City:
State:
You can pay your deposit now and make a balance payment on or before May
26, 2008.
Please select the number and amount for
deposits being paid, or select (Make Payment) to pay on your unit's account.
Select Payment Type
Make Payment
1 Participant - deposit of $50
2 Participants @ $50 each = $100
3 Participants @ $50 Deposit each = $150
4 Participants @ $50 deposit each = $200
5 Participants @ $50 deposit each = $250
6 Participants @ $50 deposit each = $300
7 Participants @ $50 deposit each = $350
8 Participants @ $50 deposit each = $400
9 Participants @ $50 deposit each = $450
10 Participants @ $50 deposit each = $500
11 Participants @ $50 deposit each = $550
12 Participants @ $50 deposit each = $600
13 Participants @ $50 deposit each = $650
14 Participants @ $50 deposit each = $700
Attending:
Select Your Program Date
Week #1 - Booked
Week #2 - Booked
Week #3 - July 6-12, 2008
Week #4 - July 13-19, 2008
Special Booking Date
If making an additional payment, please
indicate the amount of payment.
Payment Method: Credit Cards Only
Credit Card Type:
Select Card Type
Discover
MasterCard
Visa
Card Numbers:
Expiration Month:
Select Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Year:
Select Year
2006
2007
2008
2009
2010
2011
2012
2013
2014
Name as it Appears on Card: