Payment Plan

FIRST NAME *

LAST NAME *

E-MAIL *

CONFIRM E-MAIL *

CELL PHONE *

TOTAL AMOUNT OF PAYMENT PLAN *

AMOUNT YOU CAN AFFORD NOW *

AMOUNT TO CHARGE MONTHLY *

CREDIT CARD NO. (no spaces) *

CONFIRM CREDIT CARD NO. (no spaces) *

3-DIGIT SECURITY CODE *

CONFIRM 3-DIGIT SECURITY CODE *

EXPIRATION DATE *

CONFIRM EXPIRATION DATE *

ZIP CODE *

CONFIRM ZIP CODE *

DATE TO BEGIN CHARGING YOUR CARD *

LANTURNA EVENTS YOU HAVE ATTENDED *

TOTAL IN YOUR PARTY 11 AND OLDER, INCLUDING YOURSELF *TOTAL IN YOUR PARTY 11 AND OLDER, INCLUDING YOURSELF*12345678910

TOTAL IN YOUR PARTY AGES 4 - 10 *TOTAL IN YOUR PARTY AGES 4 - 10*012345678910

TOTAL IN YOUR PARTY AGES 1 - 3 *TOTAL IN YOUR PARTY AGES 1 - 3*0123

ADDITIONAL INSTRUCTIONS

0 + 3 = ?Please prove that you are human by solving the equation *