Course Payment Page Form - Child Care Council

Comments

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Registrant Information

If paying for multiple courses/attendees or services, please include details in the Notes section below.

Service / Course Title*

For courses, enter the course title. For invoices or other payments, identify the service or enter relevant details.

Course Date*

If a multi-session course, please list the date of the first meeting.

Location*

Attendee Name(s) (First and Last)*

Provide the first and last name of all attendees.

Business / Center Name

Payment Information

Child Care Council Membership # (if applicable)

Total Cost*

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Total Cost (Mirror)

Credit card convenience fee: A 3% fee will be applied to all transactions over $499.99. This fee covers credit card processing costs and is non-refundable.

Prefer to pay another way? Child Care Council, Inc. also accepts payment by check, cash, or money order. Please mail to:

Child Care Council, Inc.
595 Blossom Road, Suite 120
Rochester, NY 14610

Convenience Fee

Price: $0.00

Amount Due

Credit Card Information

Cardholder Email*

Cardholder Phone*

Notes