Official Escort Entry Form
Name: ________________________________________________________________
Address: ______________________________________________________________
City: _________________State: ____________Zip: _______________
Phone: _____________________________Cell:____________________________
Email: ______________________________________________________________
Date of Birth: _____________________________________
(Must be 18-30 years old)
Father’s Name: _________________________________________________________
Mother’s Name: _________________________________________________________
Sisters and Brothers:
Name: __________________ Age: ______ Name: _________________ Age: _______
Name: __________________ Age: ______ Name: _________________ Age: _______
Name: __________________ Age: ______ Name: _________________ Age: _______
Business or Family Sponsorship Name:_______________________________________________
Irish surnames in your family: _____________________________________________________________
______________________________________________________________________________________
Signature: _____________________________________________
Date: ________________________________________________________________
Return completed form with $100.00 business or family Sponsorship fee made payable to Lovely Events Inc. by March 21, 2012.
Mary Kay Gavin-Marmo & Deirdre McNulty-Kochuparambil
11137 S. Artesian
Chicago, Illinois 60655
773-239-3927
