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Holiday
Luncheon Registration
Form
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Registration
due by Nov. 15th. (Payment due by Nov. 15th)
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Payable to: Love Helps, inc., P.O. Box 669,
Madison, TN 37116
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Fed. ID:
62-1600206
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By completing and submitting
this form, you are committing to participate in our event
and make payment as you indicate below. If you have any
questions, please contact
us.
NOTE: all fields in Bold or marked with a (*)
must be filled in prior to submitting form.
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Company:*
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Title
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First Name
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Last Name
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Suffix
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Contact:
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*
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*
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*
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Contact Person's Mailing Address &
Phone Information
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P.O. Box or Street Address including Suite/Apt.
No.
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*
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City:
*
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State:
*
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Zip:
*
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area code
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phone number
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Wk Phone
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Wk Fax
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Hm Phone
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Contact Person's email:
*
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Sponsorship
Level, if any
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Amount:
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Tables/Guests in addition to
sponsorship above
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Number of tables of 8 at $1,500 each:
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Amount:
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Number of individual seats at $250
each:
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Amount:
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Total amount including
sponsorship:
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*
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Comments:
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We will contact you in December to confirm the
names of your guests.
You can also print this form out BEFORE submitting it
to keep a copy for your records.
BEFORE submitting, check that all fields with a (*)
have been filled in.
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Click to clear all:
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Click to send:
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Thank you for registering! Please contact
us if you have any questions.
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