Yes, I wish to
schedule an MSAS Program!
Name of organization:
Name of contact person:
Work phone: ___________________ Home phone:
Address: _________________________________ City:
State: ________________ Zip: _______________
1. Education Program: grade level:
_____ 2. Private Program: YES NO (circle one)
*Program date requested: ___________________ Starting
I have a current MSAS Classroom Membership. YES NO
I would like to purchase an MSAS Classroom Membership
YES NO (Renewable in October)
____________________@ _______________= __________
Number of student participants: ___________ @
Number of adult participants: _____________ @
Processing fee for school vouchers: $ 10.00
____________________ = _________
Nonrefundable deposit to hold scheduled date @ $50.00 = _________
Total Amount: $ ____________________
____ Enclosed is a check for the total amount.
____ Enclosed is a school voucher for the total
amount, plus processing fee.
____ Charge my credit card for the total amount.
Card type: VISA, MASTERCARD, AMERICAN EXPRESS
Card number: ______________________________________
Card holders name, if different from above:
Signature of card holder:
Please make checks payable to: Mtn. Skies
SEND form and payment to: P.O. Box 1169
Lake Arrowhead, CA 92352
* You will be contacted at the phone number that you
placed on this form to confirm availability of
requested program date and time. Please call the
MSAS office at (909) 336-1699 to confirm availability
prior to sending this form.