BRC COLLEGE TOUR THE FALL 2013 EDITION STUDENT REGISTRATION FORM

Complete the required form and mail, email, or fax to the following: By Mail: BRC Foundation, 1815 Abbots Hill Drive, Orlando, FL 32835 Scan and Email to: campustours2013@gmail.com OR Fax To: (407) 271-8812 Visit Us Online at www.campustours2013.com for updates and to make online payments! Personal Information
Name__________________________________________________________________ ( Date of Birth ________________________ Phone Number ( ) Male ( ) Female

) __________________________________

Address __________________________________________________________________________________
Street Address City Zip

Email Address: ______________________________________________________________________________ Name(s) of Parent(s) or Guardian _______________________________________________________________ Parents/Guardians Phone Number ( ) ________________________________________________________

Parents/Guardians Email Address: _____________________________________________________________

School Information
Name of High School: _________________________________________________ Grade: _________

Yes, I am interested in attending the BRC College Tour Fall 2013. I will agree to attend all of the mandatory meetings, complete the required forms, and pay the program fees as outlined below. I would like to reserve the following room accommodations for the tour: Quad Occupancy (4 students to a room) $475.00 per person
Double Occupancy (2 students to a room) $625.00 per person ALL FEES ARE NON-REFUNDABLE UNLESS TRIP IS CANCELLED BY BRC FOUNDATION

I understand that an installment payment plan is available. I further understand that adherence to the payment plan and dates are imperative. Late payments will jeopardize my participation in the tour. I understand that all fees are non-refundable unless the tour is cancelled by BRC Foundation.
Make checks payable to: Beverly Robinson Campbell Foundation or Pay online at www.campustours2013.com
Registration Fee 1st Installment Payment 2nd Installment Payment 3rd Installment Payment Final Payment INSTALLMENT PAYMENT PLAN: $75.00/$125.00 for Double Occupancy $100.00/$125.00 for Double Occupancy $100.00/$125.00 for Double Occupancy $100.00/$125.00 for Double Occupancy $100.00/$125.00 for Double Occupancy May 15, 2013 June 15, 2013 July 15, 2013 August 15, 2013 September15, 2013

*Program costs can be reduced or eliminated by participation in individual fundraising activity.

Students Signature

Date

Parents Signature

Date