Notre dame academy

Scrip Program Registration

Participant Name(s) _____________________________________________________

Address  _______________________________________________________________

City _____________________________ State _____________ Zip________________

Home Phone (        ) _________________   Work Phone (        ) _________________

(Please indicate the phone number where you can be contacted on Monday mornings in case of order questions.)

Email Address for Scrip Correspondence __________________________________

                                                                                                                                          (Required)

Program Designee  ______________________________________________________

(See approved designees on Scrip Program Policies form.  Designee may be changed at any time prior to annual distribution of earnings.)

Participant has read, does understand, and will abide by the general policies of the Notre Dame Academy Scrip Program.  The participant further understands that email will be the official method of communication of the Notre Dame Academy Scrip Program.  All official correspondence will be distributed from the email address scrip@nda.org.

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Signature

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Printed Name

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Date

This Registration Form may be submitted with your first order!  The order deadline is Monday, 9 a.m.