St. Petersburg Yaht Club (map)
Keynote Speaker, US Congressman C.W. “Bill” Young
Guest Speaker, St. Petersburg Mayor Bill Foster
*
9-11 Prayer Delivered by Bay Pines VA Chaplain Father Thomas Dieter
*
Special Guests
DAR Florida State Regent, Col Barbara Makant, USAF
“Paws for Patriots,” Cpl Michael Jernigan, USMC with Guide Dog, Brittani and
Lt Col Kathy Champion, US Army with Guide Dog, Angel
*
Acclaimed Vocal Artist, Erica DiCeglie
*
$30 Per Person (Includes Breakfast & $10 Donation to Paws for Patriots)
Program Sponsorship:
Platinum $500—Gold $250—Silver $125 —Friends $30+ & In-Kind
Checks Payable to: Saint Petersburg Chapter DAR
Mail to: Pam Hinds, Program Coordinator
6152 115th Place, Seminole, FL 33772
[masked] * [masked]
Your Check is Your Reservation * Deadline: August 10, 2010 Registered 501(c)3 — Donations are tax deductible * Guests Welcome
Copy and paste the registration form below to wordpad or notepad and send it to the addresses below
REGISTRATION FORM
PATRIOT DAY 9-11 PRAYER BREAKFAST September 11, 2010
7:45 Registration—8:15 a.m. Breakfast, St. Pete Yacht Club
MAKE CHECK PAYABLE TO: SAINT PETERSBURG DAR 501(c)3—Donations are tax deductible
NAME: _____________________________
EMAIL: ______________________
DATE: ___________
STREET: _________________________
CITY: _________________________
STATE: _________ ZIP: _______________
PHONE: ____________________
CELL PHONE: ______________________
GUESTS: ______________________________________ _____________
PAID BY CHECK: CHK NO: _________
CASH AMT: ____________________
SPONSOR—NAME: ___________________________________________
AMOUNT: ___________________________________