MONICAL'S PIZZA® Community Day Registration Form

PLEASE NOTE:
    Registration is closed for 2011.
    Please scroll to see our 2012 calendar for available dates.

Please note that this form must be fully completed in order to be considered for a fundraiser event.

Community Days are limited to Monday or Tuesday and there can be only one event per community, per day.

Full details regarding this program are available in the "Community Day Overview".

A fundraiser is only considered scheduled once you receive confirmation of your date and participating location/s. All requests must be submitted at least four weeks prior to the requested fundraising event date (six weeks preferred).

You will be contacted within two weeks of receiving your Fundraiser Request Form.

		indicates required field
Contact Name
Organization Name (Max. 35 characters)		(As you want it to appear on your flier)
Check will be mailed to:
Street Address
City
State		Please Select Alabama Alaska Arizona Arkansas Armed Forces-AA Armed Forces-AE Armed Forces-AP California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Phone (Include Area Code)
Alternate Phone (Include Area Code)
Email Address
Community Day Date		(Available Monday or Tuesday only. THIRTY DAYS NOTICE REQUIRED)
Alternate Community Day Date		(Available Monday or Tuesday only. THIRTY DAYS NOTICE REQUIRED)
Fliers mailed to nearest Monical's		Please Select Arcola, IL Avon, IN Bloomington, IL - Eldorado Bloomington, IL - Veterans Pkwy Bourbonnais, IL Canton, IL Centralia, IL Champaign, IL - N. Mattis Champaign, IL - W. Kirby Charleston, IL Chillicothe, IL Clinton, IL Danville, IL - N. Vermillion Danville, IL - North Bowman Decatur, IL - Mt. Zion Decatur, IL - Prospect Dr. Decatur, IL - W. First Delphi, IN El Paso, IL Fairbury, IL Fishers, IN Gibson City, IL Gilman, IL Greencastle, IN Greenwood, IN Hoopeston, IL Indianapolis, IN - Glendale Mall Indianapolis, IN - Lawrence Indianapolis, IN - Traders Point Mall Kankakee, IL Kentland, IN Lafayette, IN Mahomet, IL Manteno, IL Mattoon, IL Monticello, IL Monticello, IN Morton, IL Normal, IL Olney, IL Paxton, IL Pekin, IL Peoria, IL - N.Knoxville Peoria, IL - Willow Knolls Pontiac, IL Princeton, IL Rantoul, IL Robinson, IL Shelbyville, IL Springfield, IL St. Joseph, IL Sullivan, IL Terre Haute, IN Tilton, IL Tolono, IL Tuscola, IL Urbana, IL Villa Grove, IL Washington, IL Watseka, IL West Lafayette, IN
State for Your Community Day		Please Select Illinois Indiana
Area for your Community Day		Please Select
Amount of Fliers to be Printed		Please Select 50 100 250 500
Flier Color		Please Select Light Blue Yellow Green Salmon Gold Pink Ultra Pink UltraOrange LimeGreen Orchid Lemon Red
Requested Location(s) (Select Up to Four)
Additional Comments
I have read and agree to the terms and conditions