|
TRIP REGISTRATION FORM
Please print this page, and mail or fax the completed form to:
PACE - TRIP
1508 Alexander St. SE, Grand Rapids, MI 49506
PHONE: 616-574-6030 FAX: 616.574.6032
TRIP ACCOUNT # ___________________________________________________________(to be assigned by office)
PARENT NAME(S) __________________________________________________________________________
____________________________________________________________________________
ADDRESS ________________________________________________________________________________
CITY _______________________________ ZIP __________________ PHONE _________________________
EMAIL ADDRESS ___________________________________________________________________________
If you would like your TRIP credits to be directed to more than one account, please indicate each name, account number, and percentage to be received below.
PLEASE DIRECT MY REBATES TO:
□ MY PERSONAL FAMILY TUITION ACCOUNT – 100%
□ OTHER FAMILY TUITION ACCOUNT:
NAME ___________________________________ ACCOUNT # _______________ % _________
NAME ___________________________________ ACCOUNT # _______________ % _________
□ CHURCH CHRISTIAN EDUCATION FUND _______________________________ % _________
(Name of Church)
□EAGLES FUND (General Tuition Assistance) - Account #169999 % _________
□GR CHRISTIAN MIDDLE SCHOOL TUITION ASSISTANCE FUND - Account #253 %__________
I / WE UNDERSTAND AND AGREE TO THE POLICIES AND PROCEDURES OF THE TRIP PROGRAM
SIGNATURE __________________________________________________ DATE _____________
__________________________________________________ DATE _____________
IF YOU HAVE ANY QUESTIONS PLEASE CALL THE TRIP OFFICE AT 574-6030
|
