Preview Bill Payment Schedule

PaymentPlanAuthorizationForm

Iwouldliketoenrollinautomaticbilling.IauthorizeNWSRAtobilldirectlytomy:

Pleasecheckone:

Amex Visa MasterCard Discover

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PleasePrintClearly

Nameasitappearsonthecreditcard:

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E‐mailAddress:

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CardNumber:

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ExpirationDate:

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AutomaticBillPaymentSchedule

TobecompletedbyOfficeStaff:

Fundswillbedebitedaccordingtothefollowingschedule:

Season 1/3 of amount debited Second 1/3 of amount debited Final 1/3 of amount

debited

Winter/Spring Registration Deadline February 1 March 1

Day Camp Registration Deadline July 1 August 1

Summer Registration Deadline July 1 August 1

Fall Registration Deadline October 1 November 1

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Tobecompletedbyregistrant:

IauthorizeNWSRAtoautomaticallywithdrawpaymentsintheamountshownfromthelisted

accountonthedatesprovidedabove.IagreethatfundswillbeavailableandthatNWSRAwill

withdraw1/3ofthetotalregistrationamountoneachofthedateslistedon

thewithdrawal

schedule.

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Signature:Date:

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