Spark of Life - Fundraising Events

Spark of Life - "Empower One, Inspire Many"

Fundraising Events

4th Annual "Smart Girls" Retreat

in collaboration w/the

Southside Boys & Girls Club

Theme: Passport to Leadership: Taking Charge of My Future

When: Friday, July 13, 2012

Time: 9 p.m. - 8 a.m.

Location: Southside Boys & Girls Club

2409 Bainbridge Street

Richmond, VA 23225

Cost: $25 (Includes: Workshops, activities, tons of fun, dinner,

goody bag, breakfast and snacks)

*What Registrants Need To Bring to Retreat:

-Appropriate pajamas

-Appropriate workout clothes (please wear to retreat)

-Toiletries

-Pillow & Blanket or Sleeping Bag

There are only 50 spots available!!!!

Complete the registration form below on this page or via Microsoft Word/.pdf (attachments below) and e-mail or regular mail the Word or scanned document

to executivedirector@sparkoflife08.com or

Tabatha M. W. Spurlock

Spark of Life

808 Bogart Road

Richmond, VA 23223


Registration Form - 4th Annual "Smart Girls" Retreat
Theme - "Passport to Leadership: Taking Charge of My Future"
Location - Southside Boys & Girls Club - 2204 Bainbridge Street
Date: Friday, July 13, 2012 (9:00 p.m.) - Saturday, July 14, 2012 (8:00 a.m.)
Name
Birthday
Current Age
Address
Phone Number (h)
Phone Number (c)
Name of Parent/Guardian
E-mail
Emergency Contact (Name/Number/Relationship)
Allergies
Payment Details - Payable to Spark of Life Check Cash Money Order PayPal
Spark of Life has my permission to use my and/or my child's photograph, video and audio recordings, likeness, artwork, profile and/or story in future publications, web pages and other promotional materials produced, used by and representing Spark of Life. I understand the circulation of the materials could be worldwide and that there will be no compensation to me for this use. Yes No - No photos/videos for my child and me.
Parent/Guardian's Signature and Date