| Name of your organization:_______________________________ |
| Contact Person:_____________________________________ |
| Phone #:___________________________________________ |
| Event:_____________________________________________ |
| Address of event:_____________________________________ |
| Date and time:__________________________________________________ |
| Number of clowns desired:_______________________________________ |
| Donation to the 'Sneaker Fund':_____________________________________ |
| Return to Bruce 'Speedy' Garvin |
| Fax: 821-0175 |
| Voice: 821-0096, 922-2689 |
| Email: Speedy@ShrineClowns.com |