Donor Dinner Registration
   
Name:
Address:
City: State:
Zip:
Phone:
eMail:
Comments:
   
Purchase Seating

I need # of seats ($175 each person)
      or # of tables ($1750 each table, 10 people to a table)

      or # of Platinum Sponsors ($12,000 each, 1 table, 10 people to a table)

      or # of Gold Sponsors ($6,000 each, 1 table, 10 people to a table)

      or # of Silver Sponsors ($5,000 each, 1 table, 10 people to a table)
 
Seating Preference
 No preference
 I would like to sit with these individuals...
    (please list full names separated by comma in the box below)
 
Payment Method
I will phone in my credit card information
I will mail my check or credit card information