Your phone number:

Your e-mail address:

What type of an event is this?
Family Event
Fundraiser
Both

Are you interested in volunteering your time to help put on this event?
(You will be contacted if this event is selected to be held)
Yes
No

Are you interesting in attending Fundraiser Meetings with the Homecoming Committee?
Yes
No
I'd need more information

Are you currently attending the Family Support Group Meetings?
Yes
No, but I'd like to if I had more information about them
No, and I'm not interested in coming

Is it ok to contact you if more information is needed about this event?
Yes, either by phone or e-mail
Yes, but only by e-mail
Yes, but only by phone
No

Please describe, in detail, the event that you are suggesting: