Student Mission Trip- Payment 2

How many students are you completing payment for?

Student Name*

First Last

Student Names

Student 1	Student 2

Student Names

Student 1	Student 2	Student 3

Student Names

Student 1	Student 2	Student 3	Student 4

Parent or Guardian Name*

First Last

Parent Email*

Parent Cell Number*

What campus do you attend:*

Total trip cost is Student=$350, Chaperone=$200. This includes lodging & food for the week, the free-day activity, and food on the return trip home.

Full payment at the time of registration is encouraged, but not required. Payment deadline: May 15, 2025.

I will pay this via:*

Total

$0.00

PAYMENT Information:
Please make checks payable to PCC On the memo line please include: Columbus County, NC Mission Trip & your students name
Checks may be mailed to PCC Attn: Ellis Hopson PO BOX 834, Powhatan VA 23139
After completing your registration, you’ll receive an email with a link to make an online payment if you haven’t paid in full.

PAPERWORK Information:
Paperwork must be completed for each student
Be sure to have Participation form notarized if your student is under 18
Once complete, return to your campus Student Coordinator or mail to PCC Attn: Ellis Hopson PO Box 834, Powhatan VA 23139

You may also submit checks:

Via mail to
PCC
Attn: Ellis Hopson
P.O. Box 834
Powhatan, VA 23139

When you submit this form, you will be redirected to a payment page where you can pay via credit card or Paypal. You do not need to login to Paypal. Simply look for the button that says “Pay with Debit or Credit Card.” Online payments include an additional 3%+$0.25 processing fee. Please select “Check” as your payment option to avoid this fee.

Payment Method

Configuration Required: To use the PayPal Checkout field, please configure your PayPal Checkout Settings.

Total

$0.00

The Promise Of God

Life Change After Loss

May 26 at 6:30 pm

Aylett Students End of Year Party & Senior Celebration

Locations

Guidance

PCC