Name(s):

Address:

Telephone:

E-mail:

Individual reservation(s) at $250 each

Please seat me/us with:

I/we prefer vegetarian meal(s)

I/we wish to purchase raffle tickets at $20 each or 3 for $50. Raffle items include a MacBook laptop, iPod touch, and Bose noise-cancelling headphones. Raffle tickets may be purchased anytime prior to the drawing at the benefit. You need not be present to win.

I/we wish to make a tax-deductable donation of $