BANQUET REGISTRATION

Register for the Banquet

First and Last Name(s)(Required)

Are you planning to attend ComfortCare's Spring Fundraising Banquet on Tuesday, April 16 at Lexington Baptist Church?

Yes! I/we will be there.

No, I/we cannot attend.

My Table Host is: (If you are a Table Host please type "Self" in this box. If you do not have a Table Host, please type "None" and we will assign you to a table.

First Last

Childcare will be provided for children 10 and under. To register your child(ren) for childcare, please include their name(s) and age(s) below.

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone

Please let us know which Church you attend:

Please let us know if you have any food allergies:

Register for the Banquet

Questions? Contact Jerelyn Anderson, Director of Events, at 540-569-9066 or [email protected].