Name: Company: Phone: () - E-mail:
Guests:
1. First & Last Names Email Address Organization Phone
2. First & Last Names Email Address Organization Phone
3. First & Last Names Email Address Organization Phone
4. First & Last Names Email Address Organization Phone
5. First & Last Names Email Address Organization Phone
0 1 2 3 4 5 6 Members $45
0 1 2 3 4 5 6 Guests $65
0 1 2 3 4 5 6 7 8 9 10 Student Members* $0
RAFFLE TICKET PURCHASE:
0123456789 Regular Raffle Ticket ($5 each) 012345 $25 Raffle Package – Includes seven Regular Raffle Tickets ($25 each pkg -- $35 value)
Special Dietary Needs/Additional Guests:
I am paying by: Credit Card Check
NO SHOWS WILL BE BILLED.
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