Flower City Habitat for Humanity’s 2010 Sponsor

th
10 Annual Leaders Build
Campbell Street/JOSANA-Rhinos Stadium Area

Participant Sign-Up Form

Name_______________________________Title_________________________________

EMAIL ADDRESS________________________________________________________

Company______________________________ Invited By__________________________

Address________________________________________________NY_______________
(Street) (City/Town) (Zip)

Work/Cell Phone__________________________________ Fax_____________________

Have you participated IN LB before? ________ If so, what year?__________
Please place an X in the volunteer slot of your choice (1 Full or 1 Half Day)

SEPT Mon. Sept. 13 Tues. Sept. 14 Wed. Sept. 15 Thurs. Sept. 16 Fri. Sept. 17
8:45 – Noon
12:15 – 4:00
A schedule confirmation, details & map will be E-Mailed to you. Lunch included!
$100.00 Participation Fee: Applies to each Leaders Build participant

You may FAX this form for Credit Card payment to 546-1549, Attn: Teresa Bianchi

Please mail Checks with this form to: FCHH Leaders Build, 755 Culver Rd., Rochester, NY 14609
____My check is enclosed
____Please charge my credit card for $_____________ Type: MC Visa Discover AMEX

Card #_______________________________________Expiration_______________

I cannot attend this year. Please accept my donation of $____________________

( ) Please send me registration information for the October 6th Leaders Build Luncheon

Questions?
Teresa Bianchi, Development & Communications Manager, 546-1470, x 305 or
tbianchi@rochesterhabitat.org