Bay Area Music Project - Monthly Tuition Form

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Use this form to set up automatic monthly tuition charges

1
Email* This field is requiredPlease type in your email address
example@example.com
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2
Name of Student(s)* This field is required
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3
Tuition Amount* This field is requiredPlease fill your family's tuition amount from the tuition sliding scale (or the amount you have agreed to with Lorrie).
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4
Date
Date
Month
Day
Year
Date
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5
Monthly Tuition Amount
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Enter
6
Recurring Monthly Tuition* This field is required
Monthly Tuition
USD for each month
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Total: $0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
2018
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
Expiration Year
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Should be Empty: