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PASS Registration Scholarship Form 2018-19

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* 1. School Information

School Name

City

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* 2. Contact Information

Teacher Name

Organizer Name

Phone

Email

Cell or alternate number to contact during summer (optional)

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* 3. Grade(s)

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* 4. Will you need a bus subsidy?

Yes

No

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* 5. If yes, what is the approximate cost of your bus or buses?

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* 6. Number of students attending

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* 7. Number of adults attending

Please choose your top 3 choices for shows you would like to attend.

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* 8. First Choice:

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* 9. Second Choice:

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* 10. Third Choice: