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2024 Diamond Use Fee Payment
PAYER INFORMATION
Do not provide work phone if not allowed to take phone calls at work.
*
First Name:
*
Last Name:
*
Mobile Phone (999-999-9999):
Home Phone/Land Line (999-999-9999):
Work Phone (999-999-9999):
*
E-mail Address:
*
Date of Diamond Use:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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2024
Comments:
* indicates required fields
SELECT FEE
$10.00 - Diamond Use Fee - 1 game
$20.00 - Diamond Use Fee - 2 games
$30.00 - Diamond Use Fee - 3 games
$40.00 - Diamond Use Fee - 4 games
$50.00 - Diamond Use Fee - 5 games
$60.00 - Diamond Use Fee - 6 games
$70.00 - Diamond Use Fee - 7 games
$80.00 - Diamond Use Fee - 8 games
