LEESVILLE LAKE'S NINTH ANNUAL BEAUTIFICATION DAY

May 19th, 2012 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



     


Roger Winters
318 Acres Court
Lynch Station, VA. 24571
434-369-4737
rwinters@leesvillelake.org