LTR Credit Card Secure Form

Miami Beach Rowing Club

Learn To Row Registration

Dates: November 09, 10, 16, 17

Class starts at 8:30am and runs through approximately through 10:30am

Participant Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Please tell us how you heard about us. *

COUPON CODE

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

CCV *

Credit Card Charge Acknowledgment *

I understand my credit card will be charged within next 24 hrs. I also understand there are no refunds.

Swimming Acknowledgement

Verification *

I hereby verify I am able to swim for at least 10 minutes

Age Acknowledgement

I will be at least 18 years old on the first day of class *

Yes

No

I understand that I will need to download the waiver of liability, sign it and submit before participating.

Participant Signature *

Signature Acknowledgment *

By typing my name above I agree this is a valid form of my signature