UHR Dance-a-thon_Layout 1 12/18/12 2:49 PM Page 1 How to Participate: ® Register by completing this form. Youth For Hospice Dance-A-Thon Friday, April 5, 2013 (snow date: Saturday, April 6) 7:30 PM - 11:00 PM (Doors close at 9 pm) At Albertus Magnus High School 798 Route 304, Bardonia, NY Open to all high school students! Complimentary refreshments will be provided by our sponsors. Proceeds benefit United Hospice of Rockland Pre-registration is strongly encouraged; Walk-ins are welcome as space allows. ® Raise money by asking friends, family and neighbors to sponsor your participation. ® Dance until you drop! ® Earn community service hours by attending! ® No outside beverages please. We will provide complimentary food and drinks. ® Minimum $25 in sponsorships requested for participation. ® Raise $100 or more to be entered in Grand Prize drawing. Great prices for highest fundraisers! ® Register early to receive a free Danceathon T-Shirt. (T-Shirts guaranteed only for pre-registrants). ® Send in your completed form and sponsorship list to address on back. HOW MUCH CAN YOU RAISE??? We request a $25 donation as your entrance fee. We hope you’ll raise more! Ask your friends and neighbors. Call your grandparents. Send a text to all your relatives! We are trying to break last year’s record, but we need your help... Registration Form: (Please Print Clearly) Name:___________________________ School___________________________ Grade___________ Graduation Year_________________ Email___________________________ Cell Number ____________________ Address_________________________ _________________________________ City_____________________________ Sponsor’s Name Amt. 1._______________________$_______ 2._______________________$_______ 3._______________________$_______ 4._______________________$_______ 5._______________________$_______ 6._______________________$_______ 7._______________________$_______ Total Enclosed $_____* *Raise $100 to be entered into prize drawing! UHR Dance-a-thon_Layout 1 12/18/12 2:49 PM Page 2 Youth for Hospice Dance Dance Dance OUR MISSION: United Hospice of Rockland provides care, hope, comfort, and improved quality of life to individuals and their families facing serious illness. We offer compassionate support to members of our community who have experienced the loss of a loved one. Send in your completed registration form with payment by March 15th to: 11 Stokum Lane New City, NY 10956 Lisa Denburg, UHR 11 Stokum Lane New City, NY 10956 Call Lisa at 845-634-4974 for more info or email [email protected] Friday, April 5, 2013 7:30 - 11 pm Albertus Magnus High School