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2010 BOX OF LOVE Registration Form

registration instructions

Organization Name:
Key Contact First Name: Last Name:
Address:
City, ST, Zip Code:      
Phone Number:
Email Address*:
Number of Boxes to be delivered:
Delivery Date preference:
Pick-Up Date preference:
Our group is keeping all the boxes we collect.
Our group is keeping a portion of the boxes we collect.
Special Instructions:
Office Use Only: