SAB Penguins Game January 29, 2026

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

PRICE REDUCED TO $25/STUDENT DUE TO GENEROUS ANONYMOUS DONATION.

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

The Student Activities Board will be sponsoring a trip to Pittsburgh for a Penguins Game vs Chicago Blackhawks on January 29th. The bus will leave from Miller Hall at 5:00pm. The puck drops at 7:00pm. The cost per student is ONLY $25 which includes your ticket and transportation. Additionally, Waynesburg University is part of the Pens College Series, so all will receive a Pens/WU 1/4 zip. All students MUST use transportation provided by the university.

If making a payment in cash, you must come to Student Services to complete the form and make cash payment.

Student Name Student Name First Last
What size 1/4 zip would you like. There are only 2 Sizes. These are Men's Medium or XL.

What size 1/4 zip would you like. There are only 2 Sizes. These are Men's Medium or XL. Medium XL I do NOT want a 1/4 zip
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 Masterard Discover American Express STOP! If you do not have a credit card, you must sign up in Student Services with a cash or check payment. DO NOT complete this form.
Email Address
Phone Phone - ### - ### ####
ID Number

I understand that I will be using University Transportation to get to and from the event.

Yes	Yes

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