NEIGHBORHOOD WATCH FUNDRAISING EVENT

Organization Name:

Name Contact Person
Street Address
City ST ZIP Code
Home Phone
Work Phone
E-Mail Address

Event Date: April 5th, 08

Event Location: Pine Bluff Convention Center

Event Time: 0800 to 2pm

Final Date for Application: March 19th . Cash, Check or Money Order accepted. Please make payable to the PBPD Neighborhood Watch Office.

8X10 BOOTH

Non-Profit Groups cost is $50.00. Booth will have 4 tables, 2 chairs. **

Individual cost is $75.00. Booth will have 4 tables, 2 chairs. **

16X 10 BOOTH

Non Profit Group cost is $75.00. Booth will have 8 tables, 4 chairs. **

Individual cost is $100.00. Booth will have 8 tables, 4 chairs. **

Participants may begin setting up 5pm to 8pm, Friday the 4th. If you need electricity, please mark that on your registration form.

What will be located at your booth? _______________________________________________

Special needs must be itemized in the comments.

Special Needs / Comments:
____________________________________________________________________________________________________________________________________________________________________

**NO ADDITIONAL TABLES OR CHAIRS WILL BE PROVIDED

Please Mail, Fax or E-Mail this form A.S.A.P. to:
Dawn Wheeler, Community Coordinator
2823 S. Poplar, Pine Bluff, AR 71603
Office# 870-535-3870, Fax # 870-535-8598
E-Mail: pb_communitycoord@yahoo.com