Membership Checkout – Bethlehem Football Webstore

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Membership Information

You have selected the Supporter - Level 2 membership level.

Name Listed in Program
Team Roster Card
Magnet

The price for membership is $300.00 now.

Membership expires after 1 Year.

Account Information

Username

Password

Confirm Password

Email Address

Confirm Email Address

Full Name LEAVE THIS BLANK

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Player Information

Full Name

Date of Birth

Student Grade

Team

Freshman

Modified

Junior Varsity

Varsity

Address

Phone

Parent/Guardian 1

Email 1

Phone 1

Parent/Guardian 2

Email 2

Phone 2

Supporter

Full Name

Address

Phone

Team

Freshman

Modified

Junior Varsity

Varsity

Billing Address

First Name

Last Name

Address 1

Address 2

City

State

Postal Code

Country

Phone

Payment Information

Card Number

Expiration Date

Security Code (CVC)

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