2011-2012 4th Graders Ski And Ride Passport Application Form
Address to Send This Application With Proof Of Grade & payment to:
4th Graders Ski and Ride Passport
PO Box 277 Tully, NY 13159
Fax Number:315-696-6567
Questions? Call: 315-696-6550 or e-mail passport@44free.com
Booklets start shipping in December.
Applications must be postmarked no later than 3/1/2012.
If you pay by check please make payable to Ski Areas of New York, Inc.

Child's Name _________________________________________________________________________________

Address________________________________________________________________________________

City________________________________________________________________________________________

State/Prov. _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  Zip Code/PC   _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _ 

Telephone Number _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _    _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _ 

Parent's E-Mail Address _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _    _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _ 

Type of Passport Desired?
[    ]  3 Free Tickets Per Area Passport - $20   /  [    ] Learn To Ski/Snowboard Passport - $20 (both for $39!)

OFFICE USE ONLY CK/MO #_____________ ___RC ___BC __NONE __OTHER

Date _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _  _ 

Credit Card Information if not paying by check/money order:
(Will appear as Ski Areas of New York on your bill)

Visa/Mastercard/Discover Number: _____________________________________

Expiration Date:____________________

Cardholder Name:____________________________________________________