2012 MARCH FOR LIFE BUS TRIP
If the TOTAL TRANSACTION AMOUNT above includes reservations for the 2012 March for Life Bus Trip (Monday, January 23, 2012) ($40.00 per seat ), please fill out the following . . .

Name and phone number for seat 1:

Name and phone number for seat 2:

Name and phone number for seat 3:

Name and phone number for seat 4:

If you are paying for more than 4 bus seats, please convey the names and phone numbers in an e-mail or by calling 814-882-1333.

SPONSORSHIP: 2012 MARCH FOR LIFE BUS TRIP
If the TOTAL TRANSACTION AMOUNT above includes a donation to sponsor or help sponsor one or more deserving March for Life participants ($40 for each full sponsorship), please indicate the dollar amount of your sponsorship here:

SPONSORSHIP: 2012 PRO-LIFE BREAKFAST ADVERTISING SPONSORSHIP
If the TOTAL TRANSACTION AMOUNT above includes a donation for an advertising / sponsorship listing in the 2012 Pro-Life Breakfast program, enter the sponsorship amount here:

RESERVATIONS: 2012 PRO-LIFE BREAKFAST WITH LILA ROSE
If the TOTAL TRANSACTION AMOUNT above includes reservations for the 2012 Pro-Life Prayer Breakfast, please fill out the following . . .

Number of regular tickets at $12.50 each:

Number of children's (ages 3-12) tickets at $6.50 each:

(No charge for children under three years old.)

MEMBERSHIP DUES
If you want to be an official member of People for Life and the TOTAL TRANSACTION AMOUNT above includes your membership dues, please indicate the dollar amount here: $

Membership dues are $20 / family, $10 / individual, $5 / student, and $5 / senior citizen.

GENERAL DONATIONS
If the TOTAL TRANSACTION AMOUNT above includes a general donation, please indicate the dollar amount here: $

I would like to make my donation in memory of

I would like to make my donation in honor of

ADDITIONAL COMMENTS OR INSTRUCTIONS