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The form below is for Online Payment only, if you would like to pay by check, please provide the information below along with a check made payable to:
Iowa Service Academies Foundation
and send to:
Janece Schmitz
2122 S Falls Dr
Pella, IA 50219
Cadet/Midshipman’s Information
Cadet/Midshipman's Name
First
Last
Class Year
Academy
Hometown
Cell Phone
Current Cadets/Mids At No Charge/Person
Entrée Preference
Asiago Crust Chicken
Iowa Pork Chop
Cheese Tortellini
Email Address
*
Cadet/Midshipman’s Name (If you have a second cadet/midshipman)
Cadet/Midshipman's Name
First
Last
Class Year
Academy
Hometown
Cell Phone
Current Cadets/Mids At No Charge/Person
Entrée Preference
Asiago Crust Chicken
Iowa Pork Chop
Cheese Tortellini
Email Address
*
Number of Attendees (not including Cadets/Mids)
*
Please enter a number from
0
to
20
.
Please list the name(s) of the person(s) who will be seated with your Cadet/Midshipman with their entrée preference as well (one per line)
Special seating requests will be considered as possible. Type one Guest per one line above.
Confirm Total Number of Guests & Payment
Number of Cadets/Mids (FREE)
*
Number of Paying Guests
1 Attendee – $60.00
2 Attendees – $120.00
3 Attendees – $180.00
4 Attendees – $240.00
5 Attendees – $300.00
6 Attendees – $360.00
7 Attendees – $420.00
8 Attendees – $480.00
9 Attendees – $540.00
10 Attendees – $600.00
11 Attendees – $660.00
12 Attendees – $720.00
13 Attendees – $780.00
14 Attendees – $840.00
15 Attendees – $900.00
16 Attendees – $960.00
17 Attendees – $1,020.00
18 Attendees – $1,080.00
19 Attendees – $1,140.00
20 Attendees – $1,200.00
Sponsor a Cadet/Mid
Total Amount
$0.00
Credit Card
*
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
Expiration Date
Security Code
Cardholder Name
Comments
This field is for validation purposes and should be left unchanged.