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Queen of the Miraculous Medal TRIP Enrollment Form
If you'd like to enroll in TRIP (tuition reduction incentive program), please complete the form below.

If you have any questions, please email
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First & Last Name *
Email Address *
Phone Number *
Please include the area code.
Address *
City *
State *
Zip *
All credits accumulated in the program should be credited to: *
If you indicated in the question above that you'd like your TRIP credits to be applied to another family, please provide the student's first and last name below.
Pick Up Method
I authorize the adults listed below to sign for and pick up my TRIP order. I understand that Q.M.M. is in no way responsible for lost of missing certificates.
Terms & Conditions
Please read descriptions carefully as TRIP may not be returned or exchanged.

Queen's is not liable for any lost or missing certificates.

Although students may bring orders to school, for safety purposes, absolutely no TRIP will be sent home with Q.M.M. students.
If you have read, understand, and abide by the general policies of the TRIP program above, please enter your initials below. *
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