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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
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 # _______________ % _________

        NAME ___________________________________ ACCOUNT # _______________ % _________

      CHURCH CHRISTIAN EDUCATION FUND _______________________________% _________
                                         (Name of Church)
      G.R.C.S. GENERAL TUITION ASSISTANCE ACCOUNT % ___________
      SCHOLARS PROGRAM (formerly E.C.C.E.S.)         % ___________


GIFT CARDS / CERTIFICATES WILL BE ORDERED AND PICKED UP AT:
            TRIP OFFICE           ROCKFORD CHRISTIAN SCHOOL

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

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