Versus Mural Battle 7.19.24

Versus Series Mural Battle

July 19th 2024 5 to 9 pm
Mural Battle 6 pm to 7:30 pm

Food -Jam A-Diamond City Sports

Fun: painting activity, Cornhole tournament, Silent Disco Party

Poetry Battle 8 pm

Register to get your FREE Food Voucher!!

Indicate if you'd like to paint too-all supplies provided.

Bringing your family? each person over the age of 14 please complete a form.

Questions? 570-331-6755 or carolyn@eocinc.org Text 570-947-1443
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County that you live in: *
Are you a U.S. Citizen Or a Permanent Resident? *
Email*
example@example.com
Cell Phone*
Please enter a valid phone number- texting is needed.
Gender:
Date of Birth *

MonthDayYear
Date
Age*
What is your race*

Hispanic/LatinoNot Hispanic/LatinoAmerican Indian/ Alaskan Native/Not Hispanic/LatinoAsianBlack/African American/Not Hispanic/LatinoWhite/Not Hispanic/LatinoNative Hawaiian/Other Pacific Islander/Not Hispanic/LatinoTwo or more RacesRace ethnicity unknown
Household Size*
e.g.,2 3
Household Taxable Income *
Did either of your parents receive a 4-year college (Bachelor's) Degree*
My highest grade completed:*
I am also interested in participating in the painting activity*
Signature: *

Clear
Parent Signature for Dependent Students.

Clear
Should be Empty:

Versus Series Mural Battle