Boys and Girls Club of St Charles County CSL
1 CLUB WAY
SAINT PETERS, MO 63376
(636) 240-9150
http://www.bgcstc.org
Boys & Girls Clubs of St. Charles County
Order Info
Summer Blast Weekly Member ($125 x 3 Kids) - $375/Wk
Account Information
* Indicates a Required Field
Payment Amount  *
Card Number  *
CVV2  *
Expiration Date  *
/
Zip  *

Billing Information
Contact Name *
Address  *
Address 2
City  *
State  *
Zip  *
Cell Phone #
Telephone #
Email
Child's Full Name (child one, child two, child three) *
Summer Blast Week (1-10) (use comma to separate weeks) Example: 1, 2, 3 *
Child's Birth Date *
BGCSTC Primary Unit (St. Charles / O'Fallon) *


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