Medieval Maidens MC

Credit card Information
Additional administration fee $75.00
not included in the plan.

Contact #:
Name:
Street Address:
City:
Zip code:
Credit Card Type (Visa, Mastercard..etc):
Credit Card #:
Expiration Date:
3 Digit Code (located on the back of CC):
	Family of 4 plan $700.00
	Family of 2 plan $500.00
	Individual plan $300.00