Register:

Name
Office Address:
City: State: Zip:
Email: Phone:

(Please check boxes and fill in the lines that apply to you.)
Work Title:

Gourmet Latin Food Lunch Included:
Yes lunch, No lunch, Vegetarian, Non-vegetarian,
Dietary Restrictions: Yes, No,
List:

Disability: I am disability-challenged.
Type of assistance needed:

Register by March 18, 2015 to guarantee a reservation.
Cancellation Policy: 90% refund after 3/18/15

Per Person Cost: $185.00
Group Rates: Call for Rates.

Enclosed is my registration, check, payable to: I Make a Difference for
$ , mailed to:
I Make a Difference, P.O. Box 39860, Greensboro, N.C. 27438
Ph.: 336-709-2061, 336-692-6346

Please choose a registration type to continue.