SPECIAL OLYMPIC HOWARD COUNTY

GENERAL INQUIRY

today’s date_________________

Please complete returning ASAP to the address below

NAME

ADDRESS

HOME PHONE

WORK/ SCHOOL ADDRESS/PHONE #

CELL PHONE

E- MAIL

Social Security #

DATE OF BIRTH

If under 18, please list your school and expected graduation year

How did you hear about us?

Interests (check all that apply)

___ Aquatics ___ Hockey ___ Office / Clerical

___ Athletics (Track & Field) ___ Powerlifting (min. age 16yrs) ___ One day events

___ Basketball ___ Skiing- Alpine ___ special events

___ Bocce ___ Skiing- Cross Country ___ Medical

___ Bowling ___ Soccer ___ computer

___ Cycling ___ Tennis

___ Equestrian ___ Volleyball

___ Figure Skating ___ softball

___ Golf

1-9-05

*Please return to (choose one) e-mail / fax / mail/

Beth Greenberg

10386 may wind court

columbia, md 21044 bjb410@comcast.net

home 410-740-1083 ¸ fax 410-740-1076 ¸ cell 301-233-1296