Fill out the form below to register:

Tickets for this event are $75.00 each*

Name
E-mail Address
Address
City, State, Zip
Daytime Phone Number
Date of Birth
Number of Tickets
Type of Payment
Credit Card Number
Name as appears on card
Expiration Date
Shirt Size (S-2XL)
Comments

* Donation requested but not required to participate in this event. All proceeds go directly to help children in our community.
Copyright 2009 Love Fund for Children