Monday, July 11, 2011

Registration form

3rd Annual Crop for the Cure
Registration Form

July 23rd, 2011

To Register
Send this form, with your payment to:

Jackie Barfield
11750 Halcyon Loop
Daphne, AL 36526

Or email me at
Sorry, no refunds.

Your Information:
Name: ______________________________
Address: ______________________________
City: __________________ St: ____ Zip: _______
Phone: ______________________________
Email: ______________________________

Payment Options ($40.00 prior to 5/25/11 and $50.00 after 5/25/11)
___ Check (payable to Jackie Barfield)
___ Cash (do this only in person)

Please list the names of all persons you wish to sit with. I will do my best to
accommodate your wishes.

You have an option of receiving one additional raffle ticket
for donating a 2-liter drink or snack to the crop. (Limit 1)
Are you interested? 
__Yes, I will bring _________________________
__ No thank you.

Additional information available at

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