Individual Registration

Please enter information in the form below to process registration for event BENFICA ELITE SUMMER IN LISBON - GIRLS CAMP.

First Name *

SurName *

Parent/Guardian First name *

Parent/Guardian Second name *

Postcode

Address

Phone *

Email *

Player's Full Name *

Any medical conditions

Position *

Club (if applicable)

Special notes

Note: a small processing fee will be added to the total before final payment is made

Parents Phone Number *

Player's Date of Birth *

Parents Email *

Coupon

Amount

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Payment processing fee

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Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

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