Thursday, March 19 and/or Friday, March 20, 2009

COMPLETE THE FORM BELOW AND REGISTER TO PARTICIPATE IN SHOW YOUR SPIRIT TODAY!
If you have any questions or need further information please call 1-800-4JimmyV.

Thank you for your support!

Show Your Spirit in the Fight Against Cancer

Please complete the following form to register.

Company/Coordinator Information:

Company
School
Organization
Other

If 'Other,' please describe:

Group Name:

Group Name: :: Please enter your group name exactly as you would like it to appear on your program materials.

Event Coordinator:

Address

Address Cont.

City

State

Zip

(No P.O. Boxes please. We can only deliver to street addresses.)

Contact Information

Phone

Fax

(Please provide a phone number that we could reach you with questions about your order.)

Total number of employees/members/students/etc. in your group:

Total number of employees/members/students/etc. in your group: :: This number will determine how many buttons you receive for your participants. We suggest you be conservative with your estimate as additional buttons may be ordered as your fundraiser develops.

Number of Locations:

Number of Locations: :: Enter the total number of locations/offices you will be coordinating

Will your organization match employee donations?

Yes
No

How did you hear about Show Your Spirit?

Questions or Comments:

Questions? Please call us at 1-800-4JimmyV

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