THE GATHERING IN CALIFORNIA

FAMILY REGISTRATION FORM

Page 2

I hereby authorize the Ontario, CA Police Department to verify the above data for security purposes.

Signature _____________________________________email address______________________________

Print a copy, sign, and mail to:

Charlene Butolph
PO Box 17
Thurston,OR 97482

BE SURE YOU SAVE A SIGNED COPY OF YOUR OWN.

We look forward to meeting you and will send you a response shortly.

This event is for all who have felt the affects of school violence. Your comments and ideas are very welcome, please email or send your comments to: Charlene at robertab@uswest.net

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