Registration Form

Renfrew County Child Poverty Action Network (CPAN)

COMMUNITY FEUD

March 28, 2009 at the Pembroke Catering Hall (307 Julien) from 6:00 p.m. – 11:00 p.m. Entry fees must be paid in advance ($120/team). Tax receipts can be provided. Also, individuals and teams are encouraged to raise pledges throughout the community. This raises much needed funds, but also awareness about child poverty here in Renfrew County. Each team can have a maximum of 8 people. There will be a table for each team which they can decorate in a theme of their choice with costumes to match. All teams are given a set of questions to answer within a limited time frame. There are approximately 10-15 questions/round with five rounds in total. At the end of the final round, the team with the most point wins the Community Feud! In the event of a tie, there will be a “sudden death” round involving the teams which are tied for first. There will be a silent auction at the event as well as prizes awarded for: the winning team (most points), best dressed (theme), most individual pledges, and most team pledges. Space is limited. Sign up now! __________________________________________________________________________

Registration Form Name of Team: Team Members:

1. 2. 3. 4.

5. 6. 7. 8.

Contact Person: Mailing Address: Email: Telephone: I have enclosed a cheque for $_____ ($120/team). Cheques to be made payable to “ The Phoenix Centre for Children and Families”. Please write “CPAN” on the front of the check. Please mail your completed registration form and cheque to: Renfrew County Child Poverty Action Network (CPAN), c/o The Phoenix Centre for Children and Families, 130 Pembroke Street West, Pembroke, ON, K8A 5M8 For more information or to reserve your spot please call: Lyn Smith, Coordinator or Shawn Gauthier, Student Child Poverty Action Network (CPAN) Tel: 613-735-2374 ext. 250 or 244 Fax: 613-735-2378