College Boot Camp Registration & Payment Parent Name* First Last Student Name* First Last School*Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Payment*Registration Fee $495Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name
