General Program Payment

Please use this general payment form only when the registration form that is specific to the AZC program is no longer available. You may access the registration form using the hyperlink provided in the acknowledgement and reminder emails you received after you signed up for the program or through the AZC Homepage.

Thank you for participating in an AZC program. We always welcome your feedback, which can be submitted via email at [email protected]

Salesforce Campaign ID
Name*
First Last
Phone
Email*
Program Fees
What was the name of the AZC program?*
What was the cost of the program?
Total Program Costs
Are you paying for lodging?
- Yes
- No
Enter Cost of Lodging
Total Lodging Costs
Would you like to donate to our Scholarship Fund?
- Yes
- No
Please enter the scholarship donation amount:
Payment Information
How would you like to make your payment?
- Credit Card
- PayPal
Would you like to cover the payment processing fees?
- Yes, I would like to cover them.
Processing Fees
Price: $0.00
Billing Address
Street Address Address Line 2 City State ZIP Code
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Total
$0.00
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Name
This field is for validation purposes and should be left unchanged.

Program Fees

Payment Information

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