Check Memo Form

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					TOP STEP FAMILY FITNESS CENTER
6787 Anderson Rd. ~ PO Box 263 ~ Meriden, KS 66512 (785) 484-9760 ~ info@topstepfitness.net ~ www.topstepfitness.net

Check Memo Form Parent/Guardian Name____________________________________________ Student Name 1___________________Class 1_________________Class 2___________________ Student Name 2___________________Class 1_________________Class 2___________________ Check #____________ Check Amount $____________________ If you receive a discount for multiple classes or families, please specify above Detail the amounts for all that is included in your check total: Tuition $ _________ What Month is Your Payment For? _______________________________ Leotard $_________________ Scrunchie $__________________ Team Fee $_______________ Other $________________ Describe: ________________ _______________________________________________________________________________

TOP STEP FAMILY FITNESS CENTER
6787 Anderson Rd. ~ PO Box 263 ~ Meriden, KS 66512 (785) 484-9760 ~ info@topstepfitness.net ~ www.topstepfitness.net

Check Memo Form Parent/Guardian Name____________________________________________ Student Name 1___________________Class 1_________________Class 2_____________________ Student Name 2___________________Class 1___________________Class 2___________________ Check #____________ Check Amount $____________________ If you receive a discount for multiple classes or families, please specify above Detail the amounts for all that is included in your check total: Tuition $ _________ What Month is Your Payment For? ________________________________ Leotard $_________________ Scrunchie $__________________ Team Fee $_______________ Other $________________ Describe: ________________ ________________________________________________________________________________

Rev. 12/08