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F / F / F / F / F /
D.O.B Gender M M M M M
City: ________________________________________________ State: _________________ Zip Code: _____________________________
Billing Address: _______________________________________________________________________________________________________
Cell #: ______________________________ Opt-in to receive text alerts? Yes ?/ No If Yes, Mobile Carrier:____________________________
Gender: M / F Email Address: _______________________________________________________________________________________
Name: (on credit card if applicable) __________________________________________________________________ D.O.B. _____/_____/_____
No personal checks accepted. Activities paid for by credit/debit subject to a 3.1% non-refundable surcharge)

____________________ ___ /___/___ ____________________ ___ /___/___ ____________________ ___ /___/___ ____________________ ___ /___/___

Mail to: City of Mobile (location), 48 N. Sage Ave. Mobile, AL 36607-2653
$_________ ____________________ ___ /___/___

REGISTRATION FORM
Make money orders payable to: CITY OF MOBILE
Student

$_________ $_________ $_________ $_________
Program / Activity Date Time Fee

__________ __________ __________ __________ __________

__________ __________ __________ __________ __________

4_________________________________
5 ________________________________
3 ________________________________
1 ________________________________
2 ________________________________

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