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Holiday
Luncheon Registration
Form
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Registration
& payment due by Nov. 15th.
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Payable to: Love Helps, inc., 2836 Logan St., Nashville, TN 37211
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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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Please send payment by Nov. 30th to:
Love Helps, inc., 2836 Logan St., Nashville, TN 37211.
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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