First Name : ______________________________________
Last Name : ______________________________________
Address :
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
Email Address : ______________________________________
Phone Number: ______________________________________
Group Name : ______________________________________
How many members are
in your group : ______________________________________
When would you like
to begin : ______________________________________
How much do you want
to raise : ______________________________________
How many packets to
you need ? : ______________________________________
Special request, or
more information about the fundraising event.
Perhaps a theme, season or holiday?
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________