MELHA UNIT's ONLY And Members of the Shrine Request For Clowns
Your Full Name
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First Name
Last Name
E-mail
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Phone Number
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Format: (000) 000-0000.
Unit Name -
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What Type of event is this.
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MELHA Approved event (ie Parades and Melha Fund raiser.)
Unit Fund Raiser
Circus Promotional
An event for me or my Family, or an event NOT related to MELHA or the SHRINE
Hospital Event
Address of Venue
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of event
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Month
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Day
Year
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Time of event
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Hour
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Minutes
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PM
AM/PM Option
until
until
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Hour
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10
20
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Minutes
AM
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AM/PM Option
Give us a brief explanation of what type of event this is
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