STC Membership Sign Up Form

STC Membership Sign Up and Credit Card Authorization

Member Personal Information
Date:
Member Name:
School:
Date of Birth:
Grade:
Member Email Address:
T-Shirt Size
Member Home Phone:
Member Cell:
Address:
City, State:
Zip:
Parent #1 Name:
Parent #1 Cell:
Parent #2 Name:
Parent #2 Phone:
Parent Email:
Emergency Contact Information
Emergency Contact Name:
Emergency Contact Phone:
Insurance Carrier:
Policy #:
Family Doctor:
Doctor Phone:
Membership and Credit Card Authorization
Yes No	I authorize Sluggers Training Center LLC to charge the following credit card for the services listed below. I understand that my card will be charged for MEMBERSHIP and the MEMBERSHIP FEE (as applicable) with the initial payment. Payments on monthly plans will be charged on the first day of each month thereafter. Payments on quarterly plans will be charged on the first day of the fourth month thereafter. Minor League, Major League and HOF memberships are one year commitments.
Card Holder Name:
Membership Package: Please check one:	Minor League Membership @ $59.99 per month Major League Membership @ $109.99 per month Hall of Fame Membership @ $149.99 per month
	Membership fees are one time charges *Memberships subject to change based on availability
Total Amount of Charge:
Purpose of Charge
Credit Card Type:	Visa Mastercard Debit Card
Card Number:
Debit Card Number:
Expiration Date:
Authorization Code:
Billing Address is different: