2016 - 2017

                                    Moose Youth Awareness Program

                            Moose Kids Talk Report No._____        

Your Name:_________________________       Email Address: _______________________

   

Address, City, State, Zip:___________________________________________________________        

Home Phone:_______________________                  Cell Phone:___________________

                                                

  Children’s Group:_________________________________________________________________

  Age Range:_____________________________         Number of Children:___________________

  Kid’s Talk Date:__________________    Day:__________________ Time:___________________

  Place:__________________________________________________________________________

Adult Host & Contact info:__________________________________________________________

Moose Lodge and/or Chapter Rep & Contact info:______________________________________

Send Completed Report To:             

                                                Moose Association Youth Awareness Coordinator

                                 

                                                                                

Street Address

                                                

                                                City                                        State                      Zip

                                        

        Email Address

Explain your presentation in detail (including skits, any costumes and/or props):

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Name:_______________________________                Moose Kid’s Talk report #__________________

        

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                     ***Yours is the VOICE that children hear***