Flamingo Form

F L A M I N G O F O R M

Please fill out this form in its entirety and contact Jamie Hodges either by email at;
PinkDramaMama@yahoo.com or by phone at 214-906-7402 to arrange for pick up.

1) Your Information:

NAME:____________________________________________
ADDRESS:_________________________________________
CITY:____________________________________________
STATE: TX
ZIP:______________
E-MAIL ADDRESS:_________________________________
PHONE:____________________ __Daytime __Evening __Cell

2) Your Chosen Method of Payoff:

___ Check: $________ (Please make out to "Susan G Komen 3 Day Walk")

___ Credit / Debit Card Online: $_________ (http://www.the3day.org/goto/PinkDramaMama --Just click on the link that will take you directly to my 3-Day Fundraising Page)

3) The Bird’s Next Destination:

*NOTE: I will have to plant them in soil somewhere, so apartments and condos without yards aren’t great options for the next location.

NAME:_______________________________________________
ADDRESS:________________________________________
CITY:_________________________________________
STATE: TX
ZIP______________
E-MAIL ADDRESS:___________________________________
PHONE:_______________ __Daytime __Evening __Cell

MAIN CROSS STREETS______________________________________________________________


4) Tell me what you think (optional)

May I contact you over the course of this fundraiser to give you updates on the progress of my fundraising? (check all that apply.)
___Yes, by e-mail ___Yes, by US Mail ___No thank you

May I flock you again next year? (It’s nice to have some starter homes, but no guarantees)
___ Yes ___ No thank you ___Unsure, contact me next year before you begin


Comments:
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