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Focus On Life Benefit Dinner & Silent Auction

RESERVATIONS

individual - $50 per person
individual table - $400 per table of 8
corporate table - $500 per table of 8
Please provide names of table guests:

SPONSORSHIPS

dinner sponsor(s)
(as is to appear on the program)

my donation is enclosed $
(minimum $100)

REGISTRATION INFORMATION

Name:

Address:

City:

State:

ZIP/Postal Code:

Phone:

Email:

Table Captain (if applicable):

TAX-DEDUCTIBLE GIFT

unable to attend - my donation is enclosed $

TOTAL FOR PAYMENT SUBMISSION

Please enter grand total: $
Pressing the Submit button below will submit the amount above to PayPal for payment processing...