S T A R S   O N   T H E   W A T E R   2008

R E G I S T R A T I O N

Name: _____________________________________

Address: ___________________________________
Address: ___________________________________

City: __________________________   State: ____  Zip: _ _ _ _ _ - _ _ _ _

Telephone (please indicate number where you can be reached most often):

home work cell

_ _ _ - _ _ _ - _ _ _ _ _ _ _ - _ _ _ - _ _ _ _ _ _ _ - _ _ _ - _ _ _ _

Email adress: ______________________________

PHiP club affiliation, if applicable: _____________________________________

*I want to win two (2) nights (Friday, August 22, and Saturday, August 23, 2008) stay in the Sheraton's Moorefield Suite ($750.00 value)! I am enclosing $_____________ for _____ raffle tickets at $10.00 each. Checks payable to PHC of Richmond. Winning ticket will be drawn August 12, 2008, and winner will be notified on August 13 via phone and/or email. Proceeds benefit Stars charities. You must be registered for Stars on the Water to win.

I am registering these people:

__________________________

__________________________

__________________________

__________________________

__________________________


I/We will be attending:

__  Friday Only ($55 per person)
__  Saturday Only ($95 per person)
__  Friday & Saturday ($130 per person)
__  Saturday & Sunday ($120 per person)
__  Sunday Only ($35 per person)
__  Entire Weekend ($150 per person)

Payment Enclosed: $________
Please make checks payable to PHC of Richmond.

Mail this form and your payment to:

Cindy Ely
Stars on the Water
12505 Cottage Cove Court
Richmond, VA 23233