ENTRY & APPLICATION FORM

Name: Success s. Kim

Address: YokSam-Dong 837-71, KangNam-Ku, Seoul

City: State: Zip: 30329

Email: zaask@aol.com

Phone 1: 404-201-2707

Phone 2: 82-70-7519-9119

Age: (as of December 31, 2006) 56 years old

Did you attend the Revolve Tour in Dallas or Sacramento, if so which one?

Community Improvement Project Title:

Project Description:
(Project will be judged on the following criteria: originality, enthusiasm, the positive
effect your event will have on the community, your effort to bring together a group of
individuals to carry-out the event, your designated allocation of grant funds, your
marketing efforts and plans to promote your event or bring awareness to your
project and the perceived feasibility of your events success.)