James Burk

238,2,2015-01-06 20:53:36,0,0,38.122.39.42,https://thequarterbackranch.com/camp-registration/?camp_name=The+Mental+Game&price=95,,USD,Approved,2015-01-06 20:53:37,6816144743,95,,1,,1,Mozilla/5.0 (Windows NT 6.3; WOW64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/39.0.2171.95 Safari/537.36,active,The Mental Game,$0.00,1,The Mental Game,Price,95,1,95,James Burk,5/18/75,XXL,5638 boca raton,dallas,Texas,75230,United States,James Burk,(972)467-0445,(972)467-0445,coachjburk@sbcglobal.net,
I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND I SIGN IT OF MY OWN FREE WILL.,5638 boca raton,dallas,Texas,75230,United States,XXXXXXXXXXXX7106,Visa,95,,,,,,,,,,,,,,,,,,,,,,,,