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Event:

Mexico Mission Trip

Date(s):

December 26, 2011 – January 1, 2012

Total cost:

$250

Deposit: $50 due Oct 5, 2011– must be attached to this form with proof of passport (deposit nonrefundable after due date) Final Payment Due: December 7, 2011 Scholarship:

If needed (circle one) ½ scholarship full scholarship

***Jr high students must be accompanied by a parent/guardian. Student name: ___________________________________________________ Parent signature: _________________________________________________


Mexico Mission Trip