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]

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

Price: $0.00

Are you paying for lodging?

Yes

Enter Lodging Costs

Total Lodging Costs

Price: $0.00

Would you like to donate to our Scholarship Fund?

Yes

Please enter the scholarship donation amount:

Payment Information

Would you like to cover the payment processing fees?

Yes, I would like to cover them.

How would you like to make your payment?

Credit Card

PayPal

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

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.

Program Fees

Payment Information

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