PLEASE PRINT AND FAX REGISTRATION TO 904-212-0727

Dr. Martin Luther King Jr.

Holiday Parade Registration

Date & Time:  Monday, January 19, 2009  

Name:_____________________________________________________________________

 Address:____________________________________________________________________

City:___________________________________State:______Zip:______________________

                                                 Group:_______________________________________________ # Participants___________

 Type of Entry:_______________________________________________________________

Phone:______________________  Fax:_______________ E-Mail:_____________________

Cell Phone:______________________  Business Phone:_____________________________

Fax -904-212-0727