Rider Lesson Payment Form

Participant Lesson Payment

Reserved for use by participants approved by New Hope for Financial Assistance
Participant's Full Name*

First NameLast Name
Payer's Full Name*

First NameLast Name
Lesson Date

MonthDayYear
Payer's E-mail*
Payer's Phone Number*

Area CodePhone Number
The payment amount may be changed only if the rider has been approved for a reduced rate by the New Hope Financial Assistance Committee. Please enter the amount you have been approved to pay per lesson.
Amount*

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USDLesson Payment Fee
Comments
You will be directed to PayPal in a few seconds after clicking "Submit", please complete all required information in PayPal. Please note, we are using the PayPal Donate form which offers the option to use flexible amounts. This is not a donation and will not receive a tax receipt.
Should be Empty:

Participant Lesson Payment