UNITED WAY OF GREATER LAFAYETTE
1114 STATE STREET :: LAFAYETTE, IN 47905
PHONE (765) 742-9077 :: FAX (765) 742-9079
Copyright © 2007. All rights reserved.
Name:
Email:
Phone:
Organization:
Organization Type (check one):
Organization Address:
City:
State: Zip: County:
Prefer vegetarian meal
Please indicate if you would like to be added to our email list serve:
Emergency Phone (Home or Cell) in case of cancellation:
Workshop:
*** If attending a whole series, be sure to select series not just one workshop.
If more than one person is attending this workshop, please list each NAME & EMAIL below:
Comments or special accommodations:
Step 1 (Check Payment):
All information is required.
