Homeshow Representative Form

Please print this form and mail or fax it with your information
to the address or phone number below.

 Address:        3905 Magazine Street              FAX Number: 504-899-5566
                        New Orleans LA 70115

  ATTENTION:  SALLY                                Date:__________________20______

  Name:_________________________________________

  Address:_______________________________________

  ______________________________________________

  Phone Number:__________________________________

  College:_____________________________Degree:___________________________

  Occupation:_____________________________________

  Interests/Hobbies:_______________________________________________________

   ____________________________________________________________________

   Civic/Community Memberships:___________________________________________

   _____________________________________________________________________

   Husband’s Name:_______________________________________

   Husband’s Occupation:____________________________

   Children:_______________________ Age:_____________________

               ________________________        _____________________

               ________________________       _____________________

               ________________________        _____________________

   How did you hear about us?__________________________________

   How long have you lived in this city?__________________________

  What is the nearest large town?  (If town is small)_____________________________

   How far away is it?_________________________

   What other home shows are being held in your area?__________________________

   What geographical areas, churches, schools, civic groups, etc. do you intend to work from? (please be specific)__________________________