Crop for a Cure in Pa 2008
Registration
To register,copy and paste the following form into an e-mail and send to cropforacurepa@dejazzd.com. Then send your deposit to the address below. If you prefer, print the form and send it with your registration fee to the address listed here. Please make your checks out to "Pam's L'il Angels - American Cancer Society". **Your e-mail registration will NOT be confirmed until your deposit is received. Package fees will not be finalized and confirmed until all roomates have registered. Deposit to hold your spot is only $50 for overnight packages, and $25 for one day packages and must be received within two weeks of your email registration. You can also use PayPal ( www.paypal.com ) to send your payment. "Send Money" to cropforacurepa@dejazzd.com account.
Andrea Fishlock
Crop for a Cure Pa
10 Lindy Dr
Barto, Pa 19504
Please register me for Crop for a Cure Pa 2008!
Name:_________ ____________________ ________
Address: ___________ ________________________
______________ _____________________
Email address: _____________________________________
Package Choice:
Ultimate Pink Ribbon Package
Mini Sleepover Pink Ribbon Package A
Mini Sleepover Pink Ribbon Package B
Circle One: Single Double Triple Quad
Full weekend Local Pink Ribbon Package__
Local Mini Pink Ribbon Package A (Fri-Sat) __
Local Mini Pink Ribbon Package B (Sat-Sun) __
Friday Only __
Saturday Only __
Sunday Only __
Roomates: ______________________________________________
______________________________________________
Tablemates: ____________________________________________
____________________________________________
Are you a breast cancer survivor? ________________
Are you a survivor of another form of cancer? ____________
Any other special needs? ____________________________________
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