TRIP REGISTRATION FORM

Please print this page and return the completed form to:

Eagle-TRIP
1508 Alexander St. SE, Grand Rapids, MI 49506
PHONE: 616.574.6030       FAX: 616.574.6032

TRIP ACCOUNT # ______________________________________________________(Assigned by GRCS office)
                 
YOUR NAME(S)      ___________________________________________________________________________

                               ___________________________________________________________________________

ADDRESS              ____________________________________________________________________________

CITY   ________________________________ STATE   __________________ ZIP _________________________

PHONE_____________________________________ EMAIL   _________________________________________



 PLEASE DIRECT MY TRIP CREDIT TO:

_____ MY PERSONAL FAMILY TUITION ACCOUNT – 100%

If you would like your TRIP credits to be donated to one or more accounts, please indicate each name, account number,
and percentage to be received below. 

_____ OTHER FAMILY TUITION ACCOUNT:

        Name ___________________________________ ACCOUNT # _______________     ______%

        Name ___________________________________ ACCOUNT # _______________     ______%

_____  CHURCH CHRISTIAN EDUCATION FUND _______________________________     ______%
                                                                                        (Name of Church)

_____  EAGLES FUND (General Tuition Assistance) - Account #169999    ____%

 _____ GR CHRISTIAN MIDDLE SCHOOL TUITION ASSISTANCE FUND - Account #253   ______%

I / WE UNDERSTAND AND AGREE TO THE POLICIES AND PROCEDURES OF THE TRIP PROGRAM  (click here to read)

SIGNATURE __________________________________________________ DATE _____________

                     __________________________________________________ DATE _____________