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ANNUAL "EMBRACE LIFE" BENEFIT DINNER

Guest Speaker: Pam Tebow, Mother of Tim Tebow, 2007 Heisman Trophy Winner

Dinner Reservation Form – RSVP by September 3, 2010

_______Yes, I/we plan to attend. Enclosed find a check in the amount of $___________
for __________ reservation(s).  or $300 for a table of 8 _________. Seating is on a first
come basis; however if you register as a group of eight or more, please list the names of
those in your group BELOW, and we will see that your group is seated together.

NAME ________________________________________________________

ADDRESS _____________________________________________________

CITY ___________________________________MI ZIP ________________

PHONE   (              )                 -                                   

CELL:     (              )                 -                                  

EMAIL ADDRESS: ______________________________________________

Additional People:

NAME ________________________________________________________

NAME ________________________________________________________

NAME ________________________________________________________

NAME ________________________________________________________

NAME ________________________________________________________

NAME ________________________________________________________

NAME ________________________________________________________

Please make checks payable to "Flint Area Right to Life" and mail to:

G-4482 N. Genesee Road, Suite C, Flint, Michigan 48506

Phone: (810) 250-0218  Email: Flint RTL@att.net  Visit us on the web: www.FlintRTL.com