Please provide the following contact information:

First Name
Last Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Phone
E-mail

Please indicate the number and type of each breakfast you would like to pre-order:

QTY	DESCRIPTION
	Children 3 and under -- FREE Pancake Breakfast
	Children 4-10 -- Pancakes ONLY Breakfast -- $4.00
	Adult -- Pancakes ONLY Breakfast -- $7.00
	Adult -- Pancakes with a Western Omelet -- $10.00
	Adult -- Pancakes with a Ham & Cheese Omelet -- $10.00
	Adult -- Pancakes with a Vegetarian Omelet -- $10.00

Please indicate the Sunday you would like your reservation:    (If you wish to reserve for multiple Sundays, please submit a separate form for each date).

Sunday, March 30

Please select a time below to indicate your reservation preference: (the latest reservation is at noon)

Reservation at 8 AMReservatoin at 9 AMReservation at 10 AMReservation 11 AMReservation at NOON

Notes: