Preschool And Business Information Form

MOMS Club

Of Forest Lake

Local Preschool and Business

Information Form

January 9. 2012

Organization/Business Name:_______________________________________________

Address: _______________________________________________________________

Phone:_________________________________ Fax: ____________________________

Email: ____________________________ Website: ______________________________

Contact Person: __________________________________________________________

Cost:___________________________________________________________________

Program Description: (include age ranges, schedule, philosophy) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Special Programs: ________________________________________________________________________________________________________________________________________________________________________________________________________________________

• Space Reserved after November 15^th ($30)
• I do not need a table
• I need a table (additional $5) limited tables, first paid first served

Round Table

Rectangle Table

• I need an outlet (additional $5) limited outlets, first paid, first served.
• I do not need an outlet

Please check appropriate circles and return to MOMS Club of Forest Lakes, by December 15, 2011. Please include payment with your registration, checks payable to MOMS Club of Forest Lake. Feel free to email the forms to jodyryan3@frontiernet.net and ask for mailing address for checks for ease; no applications will be complete without payment.