UPCOMING EVENT
FOR AUTISM SUPPORT DAILY
SHOW YOUR SUPPORT - REGISTER TODAY
http://pieceride.webs.com/tickets-reservations
Piece
Ride for Autism Registration Form
Driver Name: _______________________ ______________________
_______
Last First
MI
Address: ______________________________________________________________
______________________________________________________________
Phone:
(_____) _____ - _______ Email Address: _________________________
I agree to hold harmless all rest areas, corporations, sponsors, organizers,
volunteers, and all other locations and persons
affiliated with Piece Ride for Autism.
Driver Signature: _____________________________________ Date:
____/____/2013
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Passenger
Name: _____________________ ____________________ _______
Last
First MI
Address: ______________________________________________________________
______________________________________________________________
Phone:
(_____) _____ - _______ Email Address: _________________________
I agree to hold harmless all rest areas, corporations, sponsors, organizers,
volunteers, and all other locations and persons
affiliated with Piece Ride for Autism.
Passenger Signature: _________________________________ Date:
____/____/2013
Pre register by mailing
a completed form and check
for entry fee made
payable to Autism Support Daily to:
21 Bellevue
Street Winooski, VT 05404
The IBM Employee
Charitable Contribution Campaign
Autism
Support Daily has been approved for
IBM's charitable contribution list!
Please spread the word to family, friends and
co-workers in hopes that they may wish to support
this organization by selecting Autism Support Daily
from the list of charitable organizations.
Our deepest thanks to IBM for this
opportunity!
Of Interest...
The Next Frontier
Wednesdays at 10:00 a.m.
the first Vermont autism and disabilities
weekly radio program on
The Radiator, WOMM-LP 105.9FM
Burlington.
This program will also showcase talents
from the disability
world.
The world is ready to listen.
