Ultimate Adventures 2012 - Deposit Form Applicant name: _______________________________ Which trip(s) are you applying to participate in? Chicago Invite (3/24-25, Open) ____ Paideia Cup (4/14-15, Girls) ____ Please send $50 per trip application along with this completed form to: Josh Seamon 265 Cliff Main St. St. Johnsbury, VT 05819 Checks should be made out to Josh Seamon. Make sure to record the applicantʼs name in the memo field of the check. All checks are nonrefundable after January 22nd, 2012. Checks from trip applicants that are not accepted will be returned. By signing below you are stating that you agree to these terms. Applicantʼs signature: _______________________________ Parent/Guardian signature: _______________________________ Parent/Guardian printed name: _______________________________ Date: ________________