PALS 2015 Mail-in Registration Form Please use a separate form for each child. Forms available at www.NVEEE.org Participant’s Name __________________________________ Age______ D.O.B__________T-Shirt Size:________ Name of Parent or Legal Guardian #1 _____________________________________________________ Name of Parent or Legal Guardian #2 _____________________________________________________ Primary Address _____________________________________________ Phone: Home( City ______________________________ State________ ZIP__________ Phone: Cell(
)__________________ )___________________
Email of Parent/Legal Guardian #1 ___________________________ #2 _________________________________ TUTITION + REGISTRATION FEES PALS 2015 REGISTRATION FEE ($50) MANDATORY
$______________
(waived only for PALS 2014 attendees)
HOUSING FOR JR. + SR. STAFF ($200) MANDATORY
$______________
(add $40 for twin sheets/pillow rental fee from FIU or bring your own)
T-SHRT + ART/ACTIVITY SUPPLIES + POOL USE ($75) MANDATORY
$______________
PRE-PAY FOR MEALS AT FRESH FOOD COMPANY ($140)
$_______________
(breakfast, lunch +dinner: all-you-can-eat dining that includes: Cereal/Do-it-Yourself waffles, Oven (pizza or calzone, omelets until 2pm), Grill (e.g. burgers, fries), Homestyle (entree, vegetable, starch), vegetarian entree, 2 soups (1 is vegetarian), salad bar with fresh fruit, Mongolian Grill, sandwich station, Desserts (baked goods, ice cream) and free drinks (coffee, sodas, milk, juices).
I WOULD LIKE TO DONATE A FULL SCHOLARSHIP FOR ANOTHER STUDENT IN NEED ($465)
$_______________
(There are over 50 under privileged students who would benefit from your generous support)
I WOULD LIKE TO DONATE A PARTIAL SCHOLARSHIP FOR ONE or MORE STUDENTS IN NEED - MINUS MEALS ($325 EACH)
$_______________
I HEARBY DECLINE TO PRE-PAY FOR MEALS (A full size refrigerator is provided in each room. I will provide my student with food and/or cash. If your child is on a special diet and prefer to order specialty meals, a chaperone will be on hand to take orders and deliver those meals.
FINAL PAYMENT IS DUE BY JUNE 8TH
I DECLINE
Total Amount Enclosed: $_______________ PAYMENT
I have enclosed a check for $ _______________________ made payable to NVEEE / PALS2015. MAIL TO: NVEEE | P.O Box 23837 Fort Lauderdale, FL 33307 Please charge $___________ to my (circle one): Visa
Master Card
American Express
Discover
Card Number: ________________________________________ Expiration Date: ______ / _______ Name as listed on the card: ________________________________________________________________ Signature: __________________________________ Date: ____________________