Annual Thanksgiving Basket Giveaway 2020 Registration Fillable Form

4th Annual Thanksgiving Basket Giveaway 2021 Registration Form Registration forms must be received by November 12, 2021at 5:00 pm. You may mail your form to Women Evolving, Inc. PO Box 236804 Cocoa, Fl. 32923 or drop off your form at The Gibson Center 835 Sycamore St. Titusville, Fl. 32789 or email your form to womenevolvinginc@gmail.com Thanksgiving Baskets are limited to a first come first serve basis (with registration Families requesting a Thanksgiving Basket will be contacted by phone or email by November 15, 2021 to explain the details for receiving your food basket. If you have any questions or concerns, please contact Shalanda Smith at (321) 222-0552 or Dotralee McNeal at (321) 363-9333

First and Last Name

Phone

Cell Phone

Text OK?

Email

basket?Yes No Best way to reach you

Email

example@example.com

May we leave a message regarding your Thanksgiving

Physical Address

Identify the number of people living in your household: Adults: Male:

Male

Female

Children

name of person picking up basket on your behalf. Name of Recipient

Please check here if your basket will be picked up by someone other than yourself. NOTE: Please list

name of person picking up basket on your behalf. Name of Recipient

Yes No Do you have an oven large enough to cook a turkey?

Special food instructions, including how many in your household have dietary restrictions

By providing this information, I understand that my name and information and that of my immediate family will be given to local organizations for the purpose of any future community events. This information will only be used as is necessary to provide information regarding community based organizations and services.

Date

Basket #