"DON'T CLOWN AROUND WITH DRUGS"
REGISTRATION FORM

For More Information:
Call (713) 729-7500 / Fax (713) 754-7078
or E-mail Cinnamon

Please note that presentations must be scheduled consecutively, either in the mornings or afternoons.

Name of School:

Physical Address: Zip Code:

Mailing Address (if different): Zip Code:

Contact Person:

Telephone #: Fax #: E-mail:

Presentation Date: Time (1st Show): Time (2nd Show):

Remarks: