BUS REGISTRATION FORM FOR THE MILLION WOMAN MARCH

MILLION WOMAN MARCH

National Transportation (Print or type) Bus Registration Form

Sponsor:_______________________________________________________________

Mailing Address: _______________________________________________________

Telephone #: _________________________ Fax # :____________________________

Bus Company: __________________________________________________________

Number of Buses: Number of Passengers: ___________________________________

Origin City: ____________________________________________________________

Departure Date & Time: _________________________________________________

Date of Arrival in Philadelphia: Time of Arrival:______________________________

Hotel- Name & Location :_________________________________________________

Departure Date From Phila.: Departure Time:________________________________

MWM Issued I.D. Numbers: _____________________________________________

Route Information: Additional Comments: __________________________________

Contact Person: Date: ___________________________________________________

Telephone: Fax#: ______________________________________________________

Reviewed by Paid Date: RETURN FORM TO:

RITAGAY JAMISON

NATIONAL TRANSPORTATION COORDINATOR

Million Woman March

4601 Market Street, 4th Floor, Philadelphia, PA 19139

Questions: info@timesx2.com or by Fax to (215) 476-3681 or by telephone call to (215) 476-3683