DAUGHTERS R US "SPONSORED BY AGAPE FELLOWSHIP MINISTRIES" MARY WASHINGTON'S SEACOBECK HALL 1301 COLLEGE AVENUE FREDERICKSBURG, VA 22401 MARCH 24, 2012
FATHER AND DAUGHTERS: A PRICELESS RELATIONSHIP REGISTRATION FORM DEADLINE: SUNDAY, MARCH 11, 2012
SECTION 1:                                                   PERSONAL INFORMATION
Status: -- Father Sponsor First Name Last Name Current Address City State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Email Address Cell Phone (xxx.xxx.xxxx)     Main Course -- Entree I Entree II Entree III Tickets -- Will pickup Leave at the Church Daughters -- 1 2 3 4 Age -- Under 10 Over 10 First Name Last Name      Main Course -- Entree I Entree II Entree III Chicken Tenders Age -- Under 10 Over 10 First Name Last Name      Main Course -- Entree I Entree II Entree III Chicken Tenders Age -- Under 10 Over 10 First Name Last Name      Main Course -- Entree I Entree II Entree III Chicken Tenders Age -- Under 10 Over 10 First Name Last Name      Main Course -- Entree I Entree II Entree III Chicken Tenders
SECTION 2:                                                   BANQUET INFORMATION

Registration is $40 per person Each daughter under 10 years old is $20 per person *** A portion of the proceeds will be donated to the Branden Mason Scholarship fund and will be awarded to deserving rising college freshmen at the event. ***
SECTION 3:                                                   MAIN COURSE OPTIONS

ENTREE I ENTREE II ENTREE III KIDS ENTREE Chicken Vegetable Roulade (Boneless Chicken Breast Stuffed with Sundried Tomatoes, Asparagus and Asiago Cheese Served with a Smoked Paprika Carrot Glaze) Broiled Salmon with a Fruit Chutney Stuffed Cheese Ravioli (Oven Roasted tomato and Goat Cheese with Fresh Basil Pesto Sauce) Chicken Tenders, Macaroni and Cheese,Green Beans, and a Fruit Cup

SECTION 4:                                                   PAYMENT PROCESS

YOU MAY SUBMIT YOUR PAYMENT THROUGH OUR SECURE ELECTRONIC PAYMENT SYSTEM. PLEASE ANNOTATE YOUR GIFT AS FATHER DAUGHTERS BANQUET