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July 28th, 2012
To Register send this form, with your payment to: Jackie Barfield 11750 Halcyon Loop Daphne, AL 36526 Your Information:
Name: ______________________________ Address: ______________________________ City: __________________ St: ____ Zip: _______ Phone: ______________________________ Email: ______________________________
Payment Options ($40.00 prior to 5/31/12 and $50.00 after 5/31/12) Sorry, no refunds. Contributions are tax deductible. ___ Check (payable to Jackie Barfield) ___ Cash (do this only in person) List the names of all persons you wish to sit with. I will do my best to accommodate your wishes. (Use the back if you have more than 6 in your group.)
Registration gives you one raffle ticket, lunch, dinner, a t-shirt and a table. To get an extra raffle ticket please bring a food or drink item to share. __Yes, I will bring _________________________ __ No thank you. T-Shirt Size: Circle one: Adult S M L XL XXL
Questions: email me at email@example.com or call 251-454-9545 Additional information available at http://daphnecrop.blogspot.com