First Name *

Last Name *

Street Address *

Town, Province & Postal Code *

Phone Number *

E-mail *

Desired Training Camp Start Date: *

Humber College Program Enrollment Status: *

PAYMENT OPTIONS

Please Note: Training Camp registration fee is $197.75 ($175.00 + HST)

Payment Method: *

If paying by e-transfer:

Password you chose for the transfer: *

If paying by credit card; *

Month *

Year *

CVV #: *

Name on Card: *

If paying by cheque: