| Return to: | Marlette Price | Deadline: | March 31, 2009 | |
| 18822 Darter Drive | ||||
| Santa Clarita, CA 91351 | Tournament Dates: | April 26-30, 2009 |
| Name of School District: | ______________________________________________________________________________________ |
| Contact Person: |
______________________________________________________________________________________ |
| (E-MAIL) (PHONE) | |
| Address: |
______________________________________________________________________________________ |
______________________________________________________________________________________ |
| Number Attending: | Female | Male | ||||
| Senior (11-12 | __________ | __________ | # of Senior Division Teams | ___________ | ||
| Junior (9-10) | __________ | __________ | # of Junior Division Teams | ___________ | ||
| Middle (7-8) | __________ | __________ | # of Middle Division Teams | ___________ | ||
| Elementary (4-6) | __________ | __________ | # of Elementary Division Teams | ___________ | ||
| Adults | __________ | __________ | # of Individuals | ___________ | ||
| Total Number Attending | __________ | __________ | __________ | |||
| T-shirt Order (One per person attending) | ||||||
| XXX-Large | __________ | Large | __________ | |||
| XX-Large | __________ | Medium | __________ | |||
| X-large | __________ | Small | __________ | |||
| Extra T-Shirts at $10.00 per shirt | _____________________________________________ | Total | __________ | |||
| (how many & what size) | ||||||
| Number of Participants | Price per Participant | Total Due |
| # of Students: | times $294 | $ |
| # of Adults: | times $294 | $ |
| Plus extra t-shirts at $10 each | +$ | ||
| Sub-total | =$ | ||
| Minus $20 deposit per participant | -$ | ||
| Equals Balance Due | =$ | ||
| If you have special meal needs please describe here: | ___________________________________________________________________________________________________________ |
| **National Academic Games Tournament is funded by Accelerated Learning Foundation. Make checks payable to ALF. Pay by check only. No cashier checks or money orders for less than $10,000 can be accepted. | |||
| If you want a receipt for your payment, please check here. ________ | Tax ID # 38-3423350 | ||
| **You will be responsible for full payment for the number of people reported as of April 10, 2009. | |
| All adjustments must be made with Marlette prior to that date.** | |
| ******************************************************************************************** | |
| THIS IS TO CERTIFY THAT THE NATIONAL ACADEMIC GAMES TOURNAMENT (NAGT) AND BOARD ARE NOT RESPONSIBLE FOR ANY LIABILITIES WHICH MAY RESULT TO ANY OF THE STUDENTS AND/OR ADULTS ATTENDING THE NATIONAL ACADEMIC GAMES TOURNAMENT, AND THAT EACH SCHOOL OR DISTRICT HAS ON FILE SIGNED WAIVER AND RELEASE FORMS FROM EACH PARTICIPANT (SIGNED BY A PARENT OR GUARDIAN FOR EACH MINOR PARTICIPANT) RELEASING NAGT AND BOARD FROM SAID LIABILITY. THIS SIGNATURE ALSO CERTIFIES THAT EACH SCHOOL AND/OR SCHOOL DISTRICT HAS SECURED PERMISSION FOR STUDENTS’ PICTURES TO BE PUT ON OUR NATIONAL ACADEMIC GAMES WEB PAGE. | |
| ______________________________________________________________________ | ___________________________ |
| Signature of District Official | Date |
| For NACGP Use Only: Date Received ____________________________ | Initial: ________________ |
For further information about National Academic Games, please contact: Marlette Price.
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