Reduced or Waived Fee Request

If you represent a school or organization that might benefit from our program, but cannot afford to participate, please fill out and submit the form below. * indicates required field Date of Request April 19, 2024 * First Name * Last Name * Email * Email Again Organization EIN (if applicable) Director of your organization Address City State Please choose a state AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AA AE AP AS FM GU MP MH PR PW VI Zip Country Phone Mobile Phone Fax Other Phone Please tell us what fee assistance you are requesting and why How did you hear about us? Choose One ---- Friend Advertisement Internet Flyer Mailing Other Please tell us what times of year, month, week and day are good for your group to attend Trapeze School New York Please tell us about your group. Be sure to include number of participants, ages, program desires and special needs. Please give us one reference who is not in your organization Reference Phone Insurance * Emergency Contact * Please enter the numbers in the following image: