LEESVILLE LAKE’S 6TH ANNUAL BEAUTIFICATION DAY

Saturday, May 16, 2009

9am - 4 pm

REGISTRATION FORM

PLEASE PRINT:

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

_______________________________________________________________

Address:________________________________________________________

EMail:_________________________________Phone:____________________

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

____________________ _____ ____________________ _____

___________________ _____ ____________________ _____

____________________ _____ ____________________ _____

____________________ _____ ____________________ _____

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 on Sunday May 17? ______

Please return registration form as soon as possible to:

Sherwood Zimmerman

3514 Summerset Rd North

Gretna, Va. 24557

434-656-1826

spzim@fairpoint.net