Moore Campaign Movie Series Registration

Registration For "Reagan"

Fill out the form carefully for your attendence
Name*

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Mobile Number*
Employment Information*
Name of Employer / Position*
How will you be Paying: We can only accept cash or checks: make Check payable to MCGOP*
Please list any guests you will be bringing. Please provide first and last name.
Please advise any guest who will be paying by cash or check of the following information:

We will accept cash or check. We can only accept cash up to $50 from any one individual.

If you are writing a check, it must be a personal check. No corporate checks permitted.

Please advise your guests to be prepared to provide Name/Address/Ph#/Retired or Employed Status. We must collect this information by law.

THANK YOU FOR SUPPORTING THE MOORE CAMPAIGN THEATER SERIES!!!

Questions: Contact Elaine Bologna: PH 330-283-8073

EMail: elainebologna@gmail.com
Additional Comments
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Registration For "Reagan"