Rotating University: India Payment Form

Personal Info

* = Required

*Name
*Phone Number
*Email Address
Recipents of Payment

If other than self list each recipient.

Card Info

*Name On Card
*Card Number
*Card Type
*Expiration Month
*Expiration Year
*CCV

Billing Address

*Street
*City
*State
*Zip

Payment Options

*Enter the number of participants for each appropriate item below

Deposit: Student and Non-student  @ $500.00
Student: Balance less deposit  @ $2,750.00
Student: Full one-time payment  @ $3,250.00
Non-student: Balance less deposit  @ $4,250.00
Non-Student: Full one-time payment  @ $4,750.00

 

*Enter dollar amount for flight from Delhi to Trivandrum, if applicable

Flight Payment Amount

*Enter quantity below if you've reserved a single room as part of your trip

Single Room  @ $1,500.00
Form Total: $0.00
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