1 2 3 4 5 6 7 8 9 10 Number attending the Community Breakfast at $40 per person.

Company Name: Contact Name: Address: Address 2: City: State: Zip Code: E-mail address: Phone number: Ext: Please use the space below to indicate the name of attendees for the breakfast. I will mail a check for my donation             Please bill me I would like to pay using Paypal Please make checks payable to: Berks Encore, Attn: Community Breakfast Committee 40 N. Ninth Street Reading, PA 19601