FAMILY CARE FAIR 2007



BACK TO SCHOOL BASH and FAMILY CARE FAIR 2012

Wednesday, August 15, 2012

8:00 a.m. Set up Tables and display

10:00 a.m. Doors open for event

South Arkansas Youth Service Building

301 South Boundary Street, Magnolia, AR 71753

Organization/Business:

Contact Person_____________________________________________________

Mailing Address____________________________________________________

E-Mail Address_____________________________________________________

Phone Number_______________________

A. I/We would like to sponsor a booth YES NO

Please provide a brief description of the activity/information that you will be providing.

Please include the type of decorations/props you will use and the ages for which your activity/booth is best

suited:

______________________________________________________________________________________

Please list any equipment (props, displays, etc...) that you will bring to set up or use in you booth. Tables will be provided.

I will need an electrical outlet YES NO

Booth sponsors may make monetary donations in the amount of $10 to defray any expenses that may be occurred. This is optional. Any checks should be made out to:

Columbia County HEALTH Coalition

B. I/We will not be able to sponsor a booth, but would like to:

1. Make a monetary donation $10 $20 $50 Other___________

2. Volunteer to help at the Fair YES NO

Please return this form as soon as possible by July 30, 2012 to:

Columbia County Independent Living, Inc.

Attention: Melissa Edwards Cooper, LSW, MS

P.O. Box 944

Magnolia, AR 71754

870-234-4561

Fax: 870-234-3815

e-mail: cciliving@

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