| Parent Name | Polly Chang |
|---|---|
| Membership Status | Member |
| Phone Number | (415) 264-9419 |
| Email hidden; Javascript is required. | |
| Child's Name | Isla Chang |
| Child's Age (as of June 1) | 6 |
| Lesson choice | Thursday Intermediate 9:00 ($150.00) |
| Subtotal | $150.00 |
| Discount | -$75.00 |
| Payment Method | Credit |
| Total | $75.00 |
| Credit Card | Visa XXXXXXXXXXXX9571 |
| ACH | Account Type: Account Number: |
799 Devon Road, Moorestown, NJ 08057