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JOIN Financial Assistance

* indicates a required answer.

Please answer the following questions to request financial assistance.

1. *

Name

2. *

Street Address

3. *

City

4.*

State

5. *

Zip

6. *

Phone Number (area code first)

7. *

Email Address

8.*

Number of Children

9.*

Age Range of Children (Select all that apply.)

 (1 required)
5 - 7 8 - 10
11 - 13 14 - 16
17 - 18
10. *

Reason for Requesting Assistance

11.*

Members who receive financial assistance commit to volunteering their time to organize a PCHEA field trip during the current membership year. (Instructions for organizing field trips are provided on the web site when members log in.)

 

 (1 required)
I commit to organize a field trip.
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