SAB Kennywood Fright Night October 4, 2024

This form is ONLY for Credit Card payments of Student Activities Events. If you need to pay with cash, you must go to Student Engagement to sign up. This form is only valid when completed with a credit card payment.

Upon submission of form and credit card payment there are NO REFUNDS.

The Student Activities Board will be sponsoring a trip to West Mifflin, PA for a trip to Kennywood Fright Night Friday October 4, 2024. The bus will leave from Miller Hall at 4:45pm. The cost per ticket for students is ONLY $15 which includes your ticket and transportation.

If making a payment in Cash, you must come to student engagement to complete the form and make cash payment.

Name of Student Participating in Event Name of Student Participating in Event First Last
Name on Credit Card if Different than the Name Above Name on Credit Card if Different than the Name Above First Last
Select Credit/Debit Card Type

Select Credit/Debit Card Type Visa Mastercard Discover American Express STOP! If you do not have a credit card, you must sign up in Student Engagement with a cash or check payment. DO NOT complete this form. STOP! I have been approved for ACT 101 Funding
Are you a current MEMBER of the Commuter Club?

Are you a current MEMBER of the Commuter Club? Yes No
Email address
Phone Number Phone Number - ### - ### ####
ID Number
Will you be riding the University Transportation?

Will you be riding the University Transportation? Yes No
If you answered "No" to the question above, please sign your name below. Signing this states that you understand that there was University Transportation provided, and you are willingly opting out of using the transportation.

Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
By signing here you understand the following:

- Due to the limited number of tickets for this event, if you are unable to attend you MUST find a STUDENT replacement (you can check with the office to see if anyone is on the wait list). If no STUDENT replacement can be found, you will be responsible for paying the "full ticket price."

-This is a University sponsored event. Therefore, ALL University polices must be followed and will be enforced.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
FOR OFFICE USE ONLY