Guest Registration for Powhatan Domestic Violence Program Afternoon Tea Fundraiser - Afternoon Tea Fundraiser 5/23/26 - 1:30 PM - 3:00 PM

Code	Activity	Ages	Grades	Days	Dates/Times	Location	Fees
	Afternoon Tea Fundraiser 5/23/26 - 1:30 PM - 3:00 PM	N/A	N/A	Sat	05/23/2026 01:30 PM - 03:00 PM	Terre Haute Farm	$40.00 Res, $40.00 Non-Res

Participant Information

*First Name	*Last Name
		I am a Resident of Powhatan I am NOT a Resident of Powhatan

Birth Date	Grade	Gender
(mm/dd/yyyy)

* List the names of guests in your party.