Register for Dance Fundraiser

	May 10th, 9:00 a.m. - Noon 5443 Sheridan Dr. Williamsville, NY 14221
Participant Name:
Street Address:
City:
State:
Zip Code:
Phone Number:
E-mail Address:
Estimated Number of Participants:
Age of Participants:	Under 10 years old 10-20 years old Over 20 years old

Kids Create Hope accepts donations year-round:

Mail to: Ferguson Fund,
   P.O. Box 222,
   E. Amherst, NY 14051
Make checks payable to:
   "Ferguson Endowed Fund"

For additional information:

info@kidscreatehope.org
716-491-5545

Proceeds benefit Carly's Club and
Roswell Park Cancer Institute