Membership Payment (Roy Youth) Afterschool Tier 1 - Monthly $ 60.00 Afterschool Tier 2 - Monthly $ 40.00 Select this option only if you have been approved for Tier 2 reduced pricing. Afterschool Tier 3 - Monthly $ 20.00 Select this option only if you have been approved for Tier 3 reduced pricing. Membership Fee $ 25.00 This fee applies to participants who do not participate in the afterschool program. Total Amount Email Address * Payment InformationUse this form to submit membership or activity fees for your child/children.Head of Household Information First Name * Last Name * Phone * Enter your MoneyTrax Account Number below. You can get your MoneyTrax Account Number from your Site Coordinator or your Club's Office Assistant. MoneyTrax Account Number * Please type the name(s) of the child or children to whom this payment applies. Children * If there are specific instructions for how you would like this payment to be applied, please include them below.Notes Credit Card Information If you have a PayPal account, you can click the PayPal button to continue. Otherwise, fill in the credit card and billing information on this form and click Continue at the bottom of the page. Checkout securely. Pay without sharing your financial information. Card Type - select - Visa MasterCard Discover Card Number * Security Code * Expiration Date * -month- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec -year- 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 Billing Name and Address Billing First Name * Billing Middle Name Billing Last Name * Street Address * City * Country * - select - UNITED STATES State/Province * - none - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Postal Code * empowered by CiviCRM Sorry but we are not able to provide this at the moment. DB Error: unknown error Return to home page. Sorry but we are not able to provide this at the moment. DB Error: unknown error Return to home page.