*PLEASE PRINT THIS FORM AND FAX IT TO 301-322-XXXX
FOR THIS CAUSE, Inc.
TAKE
THE CHALLENGE 2007
Kick - Off Event
Monday, June 18, 2007
6:30 -- 8:30 p.m.
3031-322--0846
Prince George's Community College
Largo
Student Center, Community Room B & C
301 Largo Road
Largo, Maryland
Please provide the following information:
First Name _________________________ Last Name _________________________
Street Address ________________________________________________________
City _________________________ State _____ Zip/Postal Code _________________
Work Phone _________________________ Home Phone _______________________
FAX _________________________ E-mail __________________________________
No. of Attendees _____
Names of Adult Attendees
__________________________________________________
__________________________________________________
__________________________________________________
Names of Child Attendees
_________________________________________ Age _____
_________________________________________ Age _____
_________________________________________ Age _____
How did you hear about this event?
_____Radio, which station ___________ ____ TV, which station __________
_____Print, which one_______________ ____Internet/Email