2018 East Region Team Assessment Fee

STATE INFORMATION

State Association *

CONTACT INFO

First Name *

Last Name *

Email *

Phone Number

SELECT PAYMENT AMOUNT

TEAM ASSESSMENT FEE FOR L&M REFEREES AND ASSESSORS
$10 per team for every team that entered in YOUR State Cup Competition.

Select State: *

PAYMENT INFORMATION

Billing First Name *

Billing Last Name *

Billing Address 1 *

Billing Address 2

Billing City *

Billing State *

Billing Zip *

Cardholder Name *

Card Type *

Card Number *

Exp Date *

Security Code (CID/CCV2) *

Refund Policy: Non-Refundable

* Indicates Response Required

Competitions Results