_____ For the 2000-2001 school year (July 1, 2000 through June 30, 2001) at the rate of $775.00
_____ For that part of the 2000-2001 school year commencing ______________, 2000, through June 30, 2001, at the rate of $65.00 per month.
We would prefer to handle payment of the fee in the following manner:
_____ Check in the appropriate amount enclosed.
_____ Please provide the District with an invoice statement or order to purchase.
Primary Contact Person: _________________________________________________________
Position/Title: _________________________________________________________________
Address: ______________________________________________________________________
Phone: ____________________ Fax: ____________________ E-Mail: ____________________
Home Phone (for emergencies): ___________________ OP News Yes No
Position/Title: _________________________________________________________________
Address: ______________________________________________________________________
Phone: ____________________ Fax: ____________________ E-Mail: ____________________
Home Phone (for emergencies): ___________________ OP News Yes No
Position/Title: _________________________________________________________________
Address: ______________________________________________________________________
Phone: ____________________ Fax: ____________________ E-Mail: ____________________
Home Phone (for emergencies): ___________________ OP News Yes No
School District: __________________________________________________
Dated: _________________ By: ____________________________________
Print Name: _____________________________