Camper Name

Age (must be 6 or above)

​Parent (Guardian) Name

Street Address

City

State

Zip

Parent (Guardian) Telephone Number

Parent (Guardian) Email

Class Category

Class Selection​ 1

Class Selection 2

T-Shirt Size


Cardholder Name (as it appears on card)

Card Type​ (select one)

Card Number 

Security Code

Expiration Date

Amount

Cardholder Street Address

Cardholder City

Cardholder State

Cardholder Zip Code

Cardholder Phone

Cardholder Email (Confirmation will be sent)

Register
If you have questions about your online registration, contact us at info@gsmuplift.org