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Total of DVDs at 18. 00 Total Payment Enclosed Method of Payment Cash Check Charge Visa/MC Account 3 digit code Exp. Date Authorized Signature Make check payable and remit to Grayslake Park District 240 Commerce Drive Grayslake IL 60030. Student Name Opt Out TO ORDER ANY ADDITIONAL COPIES PLEASE SPECIFY THE QUANTITY BELOW AND INCLUDE PAYMENT WITH THIS FORM. Additional DVD Order Form DUE April 30 2017 PLEASE ONLY USE THIS FORM TO ORDER AN ADDITIONAL DVD OR OPT OUT OF ANY ADDITIONAL COPIES...
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