Lyndhurst, Ohio 44124

(Toll-Free) 1-888-281-1265
(Phone) 216-691-9840

Fax: 216-691-9849 or 216-691-9850

Dear Parent,

This is the form that allows you to pay by credit card for your child’s summer program. Also, listed below is the payment schedule. Please read this carefully and fax it back to our office at 216-691-9849 or 216-691-9850.

Payment Due Date

Registration Fee (non-refundable) $250 When registering

$1000 30 days following registration

1/2 Trip Payment April 16, 2008

Payment in full May 15, 2008

As a convenience, we accept Mastercard, Visa, and American Express. Please complete the bottom portion of this form with your credit card information and signature (all information must be complete). We will process the amounts designated on each signed form separately. You must submit a new form for each payment.

You may pay by check at any time during of the process. Please make checks payable to ORANIM

Please remember the total program cost must be paid in full by May 15, 2008.

Participant Name: __________________________________________________________

Program attending: ___________________ Program cost: _______________________

Credit Card Type: MC VISA AMEX Card expiration date: __________________

Credit Card #: ________________________ Amount to charge at this time: $__________

Signature: ___________________________ Cardholder's name: ___________________

Address: ____________________________ City/State: _______________ Zip: _______

Telephone #: _________________________