Steubenville Application VBS Payments This form is to submit PAYMENT ONLY. You must register using the vbspro website. Links are on: www.ecrc.us/vbs "*" indicates required fields Have you already registered for VBS on the vbspro website?*Please Select An OptionYesNoYou must register for the event before you can submit a payment. Please click here or visit https://ecrc.us/vbs/ for more information. Parent Name* First Last Phone*Email* Select week*Please select your week belowSt. Thomas Week 1: July 13-17St. Thomas Week 2: July 20-24St. Thomas Week 3: July 27-31MOG: August 3-7Number of kids*The fee is $75 for each child. It will automatically calculate your total based on the number of children you select.1 child2 children3 children4 children5 children6 children7 children8 children9 children10 childrenChildren Names*If you are registering more than one child please add a comma between each name.If you are interested in buying shirts for your child(ren) please choose the correct size and the amount below. Shirts are ONLY available for pre-order. We will not be selling shirts as a walk-up option at camp. Please Note: We will only be ordering the exact sizes and quantities that are paid for. Child Shirt XS Quantity Price: $10.00 Quantity Child Shirt Small Quantity Price: $10.00 Quantity Child Shirt Medium Quantity Price: $10.00 Quantity Child Shirt Large Quantity Price: $10.00 Quantity Adult Small Quantity Price: $10.00 Quantity Adult Medium Quantity Price: $10.00 Quantity If you would like to help cover the 3.5% processing fees for ECRC please click YES below YES CC Processing Fees Price: $0.00 Total Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Comments Δ
