Membership Checkout - Vision Prep Soccer

Membership Information

You have selected the Rookie membership level.

The price for membership is $279.00 per Year. Customers in NV will be charged 6.85% tax.

Account Information

Username

Password

Confirm Password

Email Address

Confirm Email Address

If this is for a youth registration, please enter the parent or guardian's email address above in the Account Information section. This email will be used for login and communication.

Player Type

Please select the age of the player the program will be used by. If this registration is for a youth athlete (signing up with the supervision of and payment by a parent or guardian), please select the "Youth" option. If this registration is for an adult athlete (making payment on their own), please select the "Adult" option.

Age of Player *

Youth Adult

Youth Athlete Details

First Name *

Last Name *

Country *

State *

Age *

Gender *

Parent/Guardian Details

First Name *

Last Name *

Cell Phone Number *

Relationship to Athlete *

Youth Years Playing Soccer *

Referral Source

Adult Athlete Details

First Name *

Last Name *

Cell Phone Number *

Age *

Country *

State *

Gender *

Referral Source

Full Name LEAVE THIS BLANK

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Payment Information

Pay with Credit Card

Card Number

Expiration Date

CVC

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