____Yes, I'll be at Fundraiser Adult Buffet Brunch     _____ @ $25.00 $ ________

____Yes, I'll be at Fundraiser Child's Buffet Brunch   _____ @ $15.00 $________

___ Children Under "13" Years of Age   _____ @ no charge

____Yes, I would like to buy a brunch ticket as a gift for:

Name _______________________________________________________________

Address _______________________________________________________________

_______________________________ City ____ State ________ Zip

Phone _______________

E-mail ______________

____Regretfully, I'm unable to attend, but would like to be supportive through the following
     donation:

A Donation in the Amount of: $ ________

Total Amount Enclosed (Payable to C.H.A.N.G.E. Program) $ __________

Name _______________________________________________________________

Address _______________________________________________________________

_______________________________ City ____ State ________ Zip

Phone _______________

E-mail ______________