Please fill out the following information for the Breakfast for Champions volunteer recognition event (deadline March 29):

Please Note: All fields are required. If a field does not apply, enter n/a.

Agency Name:

Contact Name:

Contact Phone:

Contact E-mail:

Agency Address

Street, City, State, Zip:

Cost for full breakfast includes 2 volunteers and 1 agency representative
$32 Volunteer Center Member Agencies
$40 Non-member agencies
$15 Extra attendee
Optional: One Youth Volunteer FREE (No adult substitutions)

Seating is limited. Please call the office if you have name changes.

Enter names of ALL attendees below

1st Volunteer name:

2nd Volunteer name:

Agency representative name:

Youth name (Free): (No adult substitution)

Extra name($15): (indicate if youth or adult volunteer or agency rep.)

Please be sure you have filled out all the fields before hitting the Send Mail button below.

Upon submission, you will receive a confirmation page verifying that your form was sent, ALONG with PAYMENT OPTIONS.

Any information you enter will not be given or sold without your permission. Submitting this form does not bind you to anything!

Volunteer Center of the Lehigh Valley

Breakfast for Champions
April 7, 2010
Attendee Registration

Agency Name:

Contact Name:

Contact Phone:

Contact E-mail:

Agency Address

Street, City, State, Zip:

Cost for full breakfast includes 2 volunteers and 1 agency representative

$32 Volunteer Center Member Agencies

$40 Non-member agencies

$15 Extra attendee

Optional: One Youth Volunteer FREE (No adult substitutions)

Seating is limited. Please call the office if you have name changes.

Enter names of ALL attendees below

1st Volunteer name:

2nd Volunteer name:

Agency representative name:

Youth name (Free): (No adult substitution)

Extra name($15): (indicate if youth or adult volunteer or agency rep.)

Please be sure you have filled out all the fields before hitting the Send Mail button below.

Upon submission, you will receive a confirmation page verifying that your form was sent, ALONG with PAYMENT OPTIONS.

Volunteer Center of the Lehigh Valley

Breakfast for Champions April 7, 2010 Attendee Registration

Agency Name:

Contact Name:

Contact Phone:

Contact E-mail:

Agency Address

Street, City, State, Zip:

Cost for full breakfast includes 2 volunteers and 1 agency representative

$32 Volunteer Center Member Agencies

$40 Non-member agencies

$15 Extra attendee

Optional: One Youth Volunteer FREE (No adult substitutions)

Seating is limited. Please call the office if you have name changes.

Enter names of ALL attendees below

1st Volunteer name:

2nd Volunteer name:

Agency representative name:

Youth name (Free): (No adult substitution)

Extra name($15): (indicate if youth or adult volunteer or agency rep.)

Please be sure you have filled out all the fields before hitting the Send Mail button below.

Upon submission, you will receive a confirmation page verifying that your form was sent, ALONG with PAYMENT OPTIONS.

Breakfast for Champions
April 7, 2010
Attendee Registration