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SATURDAY, APRIL 21, 2012
Washington County Fair Park

 Early Bird Registration – Register by March 23, 2012 and receive a $5.00 raffle ticket per attendee.

Final Registration – April 4, 2012
Reservation Form
   
This reservation is for: Individuals - $50 per person
A group of 8 at a Gold Sponsor table - $1,000
        (Includes full-page ad, 2 bottles of wine & celebrity waiter)
A group of 8 at a Silver Sponsor table - $800)
        (Includes half-page ad and 2 bottles of wine)
 A group of 8 at a Bronze Sponsor table - $600
        (Includes a quarter-page ad and 2 bottles of wine)
 

If you wish to make reservations for more than 8 people or more
than one table, please submit an additional reservation form.
 
Subtotal: $
Donation Amount: $ (If you would like to make a donation to the auction, add it here.)
Total: $
  Please select one of the following payment options:
A check will be sent from a company/organization
          Name of company/organization:
A check will be sent from a single individual
Other - Please describe below:
     
Please provide an email address to which the reservation confirmation can be sent.

Email:

First Guest:
Name: Phone: Email:
Address: City: State: Zip:
Second Guest: copy address & phone from previous entry
Name: Phone: Email:
Address: City: State: Zip:
Third Guest: copy address & phone from previous entry
Name: Phone: Email:
Address: City: State: Zip:
Fourth Guest: copy address & phone from previous entry
Name: Phone: Email:
Address: City: State: Zip:
Fifth Guest: copy address & phone from previous entry
Name: Phone: Email:
Address: City: State: Zip:
Sixth Guest: copy address & phone from previous entry
Name: Phone: Email:
Address: City: State: Zip:
Seventh Guest: copy address & phone from previous entry
Name: Phone: Email:
Address: City: State: Zip:
Eighth Guest: copy address & phone from previous entry
Name: Phone: Email:
Address: City: State: Zip:
Additional Comments: