2nd ANNUAL CIGAR SMOKE OUT AGAINST CHILD ABUSE

HOME | REGISTRATION | DONATIONS | SILENT AUCTION | PICTURES

WHERE: Bongo’s Cuban Café located at Downtown Disney’s West Side, at Walt Disney World
Orlando, Florida

DATE: Thursday, June 1, 2006

TIME: 6:00pm till 9:00pm

COST: $100 per person - includes over $100 worth of cigars, dinner, and silent auction.
$50 per person (non-smoker rate) - includes dinner and silent auction

Join us for an exciting evening of fine cigars, fine Cuban cuisine, and a silent auction, where 100% of the proceeds will be supporting the Howard Phillips Center for Children & Families. Many of your favorite cigar vendors will be represented at this event.

Please either print and fax/mail in the form or copy to word and email to mcherowitz@earthlink.net

REGISTRATION FORM
Name: _____________________________________________________________________________

Address: ___________________________________________________________________________

City: ________________________ State: _________ Zip Code: _____________

Phone #: _____________________ Fax #: _________________ Email: ________________________

# of Cigar Tickets: ___________ # of Dinner Only: __________ Total: __________________

Credit Card Type: ____________ Credit Card Number: __________________________________

Expiration Date: ______________ Name on Card: ________________________________________

Registration and payment must be received by May 28, 2006. Please make Checks payable to: The Howard Phillips Center and mail to, Attention: Michael Cherowitz, 165 Wekiva Springs Road Suite 119, Longwood, Fl 32779. Credit card payments may be faxed to: 407-786-8833 (Attention: Michael Cherowitz).

Cigar Smoke Out for Child Abuse Prevention will benefit The Howard Phillips Center for Children & Families, a part of Arnold Palmer Hospital for Children & Women, a registered 501-C 3 (Tax ID #59-1726273).
The Howard Phillips Center will receive 100% of your contributions.
Credit cards will be processed by the Orlando Regional Healthcare Foundation.

FLORIDA DISCLOSURE STATEMENT
A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION FOR THE ORLANDO REGIONAL HEALTHCARE FOUNDATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL FREE, 800 435-7352 WITHIN THE STATE OF FLORIDA ONLY. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL OR RECOMMENDATION BY THE STATE. THE FOUNDATION IS A REGISTERED CHARITABLE ORGANIZATION (SC-00577) AND DOES NOT CONTRACT WITH ANY PROFESSIONAL SOLICITORS.