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High Rock Lake River Rats Inc.

22^nd Annual Christmas Benefit

December 6, 2009; 3 pm until 8 pm

Please join us to help make Christmas merrier for those less fortunate.

Over the past 11 years, on average, we have given over $20,000 per year in assistance to over 150 families and hundreds of children.

We need your help!

Every year the number of families that need help increases.

We need donations from area businesses to help in our effort.

Please show your support by bringing us donations for our auction.

Please call Chip, 336-859-9822, for more information on how you can help.

Remember...It's for the Kids!!

Your generosity makes it all possible.

REQUEST FOR FINANCIAL ASSISTANCE

FROM THE RIVER RATS, INC.

Name of Member who told you about River Rats Assistance: ____________________________

Date of Request: _________________

Is the individual in need of help a relative of yours? Yes No

Name and address of individual in need:

________________________________
________________________________ Phone Number:______________

________________________________

What are the circumstances of their need? Please describe in as much detail as you can. Attach any additional documentation you have. _____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_________________________________________________________

Children:

Full Name Age School

____________________ ____ ______________________

____________________ ____ ______________________

____________________ ____ ______________________

____________________ ____ ______________________

Is "time of the essence"? Is it needed before the next meeting (why?) or can it wait for review by the board at that time? ____________________________________ _______________

What other avenues of assistance are being pursued? /Granted?_____

___________________

Have they ever received any prior assistance from the River Rats? If yes,

Describe:_____________________________________________________________

How much are you requesting that the River Rats donate?____________________

In what format do you suggest the donation be made? i.e. payment directly to the power company, Mortgage Company, or gift certificate to Wal-Mart, Lowe's, Food Lion, etc.___________________________________________________________

I authorize the River Rats to verify the information I have provided.

Signed____________________________________Date________________________

Written forms must be received by the River Rats by 3:00pm Friday, December 4, 2009 at

PO Box 567, Southmont, NC 27351