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ACCESS PROGRAM Response Form

If you have questions about this program, please contact Maya Ford at 713.533.6717. We look forward to working with you and providing a recreational outing.

Yes! I would like to participate!
If not, can you tell us why?
How will tickets be distributed?
When?
Agency Name:
Contact Name:
Address:
City:
State/Zip:
Telephone:
Email:
Website:
# of those served:
To participate in this program, you must be a verified 501(c)(3). Please fax your verification to 713.533.6783 upon completion of this form.
# of tickets needed:
Adults:
Children (2 – 11):
Additional Comments:

 
 
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