Athlete Payments – Eldora Mountain Ski & Snowboard Club

(303) 447-8014 info@lertprograms.com | 194 Taft Dr. Boulder, CO 80301

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Athlete Payments

Athlete Name *

First

Athlete Last Name *

Last

Athlete Age Class *

Account *

Van

Team Travel

Other (explain payment in Comments field below)

Comments *

Amount Credited to Account *

Amount Charged to Credit Card $

(includes 2.5% credit card processing fee)

Cardholder Name *

Address *

Address

Street Address

Street Address

Street Address

Street Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Email *

Credit Card, Exp Date (mm/yy), CVC *