Please complete the form below to pay for your Private Swim Lessons. **Please note that your spot(s) will be reserved only after payment is made and refunds will not be offered.** Private Swim Lessons Payment Form Name(Required) First Last Email(Required) Phone(Required)Name of Person(s) Receiving Private Lesson(Required) First Last Name of Instructor(Required)Please selectMaggie ReedMike DraminskiAnnemarie WeaverHannah DalyList Dates and Times of Lessons You Are Paying For:(Required)Quantity(Required)Please add up the total number of hours. If not a whole number, please indicate .25 for 15 minutes, .33 for 20 minutes, and .50 for 30 minutes. Hourly Rate(Required)Please selectBonded / Military Members $120/hrAssociate / Cuda Members $130/hrNon-Members $140/hrSubtotal $0.00 Online Processing Fee2.9% plus $0.30 per transaction Price: $0.00 Total Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Security Code Cardholder Name