LEESVILLE LAKE'S FOURTH ANNUAL BEAUTIFICATION DAY

May 19th, 2007 9am - 4 pm

REGISTRATION FORM

1. Name of individual or contact person filling out form:

Name:
Address:
Address:
City:
State:
Zip:
     
Phone:
Cell:
Cell:
Email:


All supplies and T-Shirts will be packaged under your name. Please inform volunteers participating in your group to not duplicate by submitting another form. Thank you.

2. If representing a large neighborhood group, indicate name of subdivision

  

3. Include your name and the names of volunteers and their T-Shirt size

Name Small Medium Large X Large XX Large


4. Is there a specific area you would prefer to clean?     No    Yes  
   Where? Please be as specific as possible


5. How many from your group plan to attend the cookout?



     


Sherwood Zimmerman
3514 Summerset Rd. North
Gretna, VA. 24557
434-656-1826
spzim@pmtnet.net
OR Sam Skillman
229 Indigo Run
Lynch Station, VA. 24571
434-309-9988
SLSKILLMAN3@aol.com
434-309-1427 (FAX)