Registration form for the Columbia Summit of Hope

Vendors and Volunteer Registration Form
for the Columbia Summit of Hope


I will be attending the Columbia Summit please indicate Vendor or Volunteer
Name of Agency:
Contact Name: (required) *
E-Mail: *
Phone:
Address:
How many will be attending from your agency:
Number of T-shirts needed and sizes If you have a shirt please wear it we have very little funding for shirts
How much table space do you need:
Additional needs (electric, etc.):
Services Provided	Correctional
	Disability
	Transportation
	Faith Based
	Income Support
	Health
	Government
	Employment
	Educational
	Child and Family
Other:
What Counties do you serve?:
Eligibility Requirements:
Describe services:

      Events

Mount Vernon Summit of Hope on January 2013 at the Rowland Lewis Building Mt. Vernon

Whiteside County Summit of Hope on Thursday January 24th 2013
HARVEST TIME BIBLE CHURCH
1802 Dixon Avenue Rock Falls, Il 61071

Metro East Summit of Hope on Tuesday February 19th 2013 at Power of Change Christian Center 2348 Jerome Lane
Cahokia,IL 62206
Chicago Summit of Hope TBA