Please fill out the information below for each person who will attend the picnic. If you have not yet become a member, please first fill out the membership form.
Names of all of those who will attend (for nametags):
Age (if child)
PICNIC REGISTRATION FORM
17th Annual Heart Picnic
First name:Last name:
Age (if child)
Number of Adults
Number of children
Copyright 2002-2016 California Heart Connection
First name:Last name:
Age (if child)
First name:Last name:
Age (if child)
First name:Last name:
Age (if child)
First name:Last name:
Age (if child)
First name:Last name:
Age (if child)
Mailing Address:
City/State/Zip
Phone number:
Email Address 1: (Important! We communicate with members primarily via email.)
Email Address 2: (a different email address if you have one.)
Please press the submit button when you are finished entering information.
I will bring:
I can help:
Potluck: This year's picnic will be a friendly, family-style potluck!
CA Heart Connection will provide drinks, desserts and paper goods.
If your last name start with:
A-E - please bring a SALAD (green salad, fruit salad, pasta salad etc.)
F-Q please bring a MAIN dish (sandwiches, pasta, casseroles, BBQ chicken, pizza etc)
R-Z - please bring a SIDE DISH (veggie tray, chips, appetizers, etc.)
Please bring enough to share for about 10-15 people. And please remember that the food will be sitting outside in the sun, so please keep mayonnaise separate (we will have ice). If you know what you would like to bring, please put it in the comments section below so we can keep track.
Comments:
DONATIONS: There is no charge for the picnic, but donations are always welcome!
Credit Cards and Paypal accepted!
(hit "submit" and you will be prompted to make your donation on the next page.)
Total number attending:
Photo release: I grant permission to California Heart Connection and its representatives the right to take photographs of me and my minor children at the picnic to publish in print and/or electronically for purposes such as publicity, illustration, advertising, promotional materials and Web content.
