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Check amount $ _______________ Number of Dinner Reservations _______ $50.00 per person - Deadline October 5
Special dietary needs:
____________________________________________________________________________
____________________________________________________________________________
Names as you would like them to appear on your Name Badges
Name _______________________________________________________
Spouse/Guest Name __________________________________________
Address
Street ____________________________________________
City ______________________________________________
State _____ Zip _____________
Phone ___________________________________________
Email ____________________________________________
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