2014 Parade Registration Form

Theme: Salute Our Veterans

Name of group, business or individual _____________________________________

Address _______________________________________________________________

Contact person(s) name _________________________________________________

Phone Number _________________________________________________________

E-mail _________________________________________________________________

Title of Entry or Theme __________________________________________________

Please Check One that applies the most:

Individual ______ Group ______ Pet________

- And -

Walkers _______ Small Float ______ Large Float ________

Cars/vehicles ________ Band ________

Other (please indicate) __________________________________________________

_______________________________________________________________________

Return form to: Anthracite Heritage Festival Parade, attn: Pam Burns, 10 S. Market St., Shamokin, PA 17872, by e-mail at burnsp@fnb-corp.com, or fax to 570-644-0897.