Form – Mesa Registration Fees

Scholar's Name*

First Last

Donor's Name*

First Last

Donor's Email*

Donors' Phone*

Donor's Address*

Street Address Address Line 2 City State ZIP Code

Note: Yearbook, PTO Dues, test fees, etc. listed below are NOT eligible for ECA Donations.

Yearbook Full Page Senior Ad (**Only Available At Registration**)

Price: $100.00 Quantity:

PTO Dues (Per Year)

Price: $20.00 Quantity:

AP Test Fee: Biology

Price: $94.00 Quantity:

AP Test Fee: Chemistry

Price: $94.00 Quantity:

AP Test Fee: Spanish

Price: $94.00 Quantity:

AP Test Fee: World History

Price: $94.00 Quantity:

AP Test Fee: U.S. History

Price: $94.00 Quantity:

Ballet Class (Per Semester)

Price: $25.00 Quantity:

Baseball Fee

Price: $100.00 Quantity:

Basketball Fee

Price: $125.00 Quantity:

Cross Country Fee

Price: $75.00 Quantity:

Dance Class (Per Semester)

Price: $25.00 Quantity:

Football *Flag Football Fee

Price: $75.00 Quantity:

Football *Tackle Football (Per season-High School Only)

Price: $225.00 Quantity:

Golf Class - Greens Fee (Per semester)

Price: $75.00 Quantity:

Soccer Fee

Price: $75.00 Quantity:

Softball *HS Girls'

Price: $75.00 Quantity:

Softball *JH Girls

Price: $75.00 Quantity:

Swimming Fee (Per semester)

Price: $150.00 Quantity:

Volleyball Fee

Price: $100.00 Quantity:

Other Payment (Enter Any Quantity)

Did you apply a payment for "other?" If so, please leave a short memo for what your payment is going towards.*

Other Payment Memo*

Do you want to apply this payment to your ECA tax credit?*

Note: Field Trips and Tours and class fees are ECA eligible, but PTO Dues, Yearbooks, play tickets, concert tickets, uniforms, etc. are NOT eligible for ECA.

Trips & Tours

Note: The fields below are donations fields, if you do not wish to donate you can leave them blank.

Independence/Liberty Tour

Science Tour

Jr. History Tour

Music Department Trip

Total

$0.00

Phone

This field is for validation purposes and should be left unchanged.