General Interest RAC Trip Payment Form 2024-2025

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* Student First Name

* Student Last Name

* Current Grade

Student Cell Phone Number

Student Email Address

Are are a member of the Teen Center?

YesNo

* Parent 1 First Name

* Parent 1 Last Name

* Parent 1 Email Address

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email Address

* Please check the box next to the trip/s for which you are committing to at this time:

Teen Center Member Rate (20% off): 10th-12th Grades RAC L'Taken Social Justice Seminar to Washington, DC January 10-13, 2025Non Teen Center Member Rate: 10th-12th Grades RAC L'Taken Social Justice Seminar to Washington, DC January 10-13, 2025

* Confirmation of Understanding

Please Select OneYesBy completing this form and submitting my payment I agree to the following payment schedule and our non-refundable deposit.

RAC Payment:
Deposit by November 1: $400 for Teen Center Members, $500 for Non Teen Center Members
Remainder by December 1: $640 for Teen Center Members, $800 for Non Teen Center Members
Non-refundable deposit deadline is December 1

* Email address

Confirmation email will be sent here.

Total

Thu, December 26 2024
25 Kislev 5785

Thu, December 26 2024 25 Kislev 5785

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