Christmas Basket Sign-up 22
Please complete the following form to show your interest in receiving a Christmas basket.  These forms will be sent directly to those coordinating the event.  PLEASE MAKE NOTE OF THE DATE/TIME YOU CHOOSE SO YOU KNOW WHEN TO PICK UP YOUR BASKET.  Forms due by November 18th. 
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Email *
Your name *
Your address *
Your phone number *
Number of adults in the home *
Number of children in the home and their ages *
People receiving Christmas baskets are asked to pick them up at the American Legion in Brimfield. Will you be able to pick up the basket? *
If you are sending someone to pick up the basket, you MUST include their name and a phone number for them.
Which date will you pick up your basket? *
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