Season for Nonviolence Event Registration

Season for Nonviolence 2002 Event Registration PARTICIPANT RELEASE – (print, sign and fax to 323 731 5442) The undersigned is an authorized representative of the organization and agrees to lend its/his/her name, and/or participation, and/or sponsorship in support of A Season for Nonviolence. NAME:________________________________________ PHONE:________________________________________ (Please Print) ______________________________________________________ (Signature) (Date Signed)

Name of Organization _______________________________________

Description of Organization _________________________________

__________________________________________________________

__________________________________________________________

Contact ____________________________________Title__________

Mailing address ____________________________________________

__________________________________________________________

Phone _______________________ Fax________________________

Email _____________________________________________________

Website ___________________________________________________

Event Name _______________________________________________

                       _______________________________________________

Type of Event _____________________________________________
                             (seminar, concert, town hall, workshop, etc)

Date (s) __________________________________

Time from ______________ to________________

Admission / Parking ________________________________________
                                               ("free" if no charge)

Venue / address / parking / directions _________________________

__________________________________________________________

Event Description __________________________________________

__________________________________________________________

__________________________________________________________
(please feel free to attach additional information)