REGISTRATION BILLING FORM
School District:

33rdCommissioner’s Academic Challenge - April 19- 21, 2018

This form and payment FOR REGISTRATIONS ONLYare due March 16, 2018.

PURCHASE ORDERS MAY BE SUBMITTEDFOR REGISTRATION COSTS.

Make checks or purchase orders payable to:School Board of Polk County

Mail to:Lisa W. RawlsTELEPHONE:(863) 298-5713

Academic CompetitionsPhysical Address: 611 Post Ave. SW

P.O. Box 391 Winter Haven, FL 33880

Bartow, FL

Two registration options are available for 2018.

Option A - $550Option B - $590

Includes: Includes:

One (1) 2 day One Park Disney Pass One (1) 2 day Parkhopper Disney Pass

Tournament lanyard and T-shirtTournament lanyard and T-shirt

$50 Disney gift card to help offset meal costs$50 Disney gift card to help offset meal costs

Meals included: Meals included:

Thursday – Continental Breakfast, Opening LuncheonThursday – Continental Breakfast, Opening Luncheon

Friday – BrunchFriday – Brunch

Saturday – Lunch, Closing Banquet Saturday – Lunch, Closing Banquet

*Tickets for a European Continental Breakfast on Saturday morning are available for purchase. Cost is

$40each.

*Additional $25 gift cards are available for purchase if teams would like to have breakfast on their own.

Teams may purchase Disney tickets for additional days on their own. Contact Lisa Rawls for more information.

No registrations will be sold after March 16.

The closing banquetis the only meal which may be purchased separately from the registration, and

tickets are available at a cost of $100.00 each prior to March 16.*

Additional park passes may be purchased PRIOR TO MARCH 16.See chart below for pricing.

*Prior to March 16, use the “Add-on” billing form available online for registrations, banquet tickets or passes.

NO REGISTRATIONS, BANQUET TICKETS OR PASSES WILL BE SOLD AFTER MARCH 16.

Line 1: / Number of Option A Registrations / 0 / $550.00 / $0.00
Line 2: / Number of Option B Registrations / 0 / $590.00 / $0.00
Line 3: / Additional banquet tickets @ $100.00 / 0 / $100.00 / $0.00
Line 4: / AdditionalSaturday breakfast tickets @ $40 / 0 / $40.00 / $0.00
Line 5: / Additional 2-day One Park passes @ $175 / 0 / $175.00 / $0.00
Line 6: / Additional 2 day Parkhopper passes @ $215 / 0 / $215.00 / $0.00
Line 7: /

Additional Disney Gift Cards @ $25

/ 0 / $25.00 / $0.00
Line 8: /

Less team grant allocation of $1,000

/ ($1,000.00)
Line 9: /

Balance due SBPC by March 16, 2018

/ ($1,000.00)

PCSB FINANCE DEPT. CREDIT: 9335100000 3440000