Printed from daMinyan.com

Dinner Form

Dinner Form

 

 

 

   BLACK TIE
                       

 

              Gala  Dinner 

 

You are invited to the dinner of a lifetime:              

 

 Cost:  $100 for an adult                                                                                  

 

 

            $80 for a student                                                                                      

 

            $900 for a table of 10 (please list the names of each person)

           ($720 and $1080, for a table of 8 and 12 respectively)         
 

 

Contact Information:

 

Name:           

Phone:                

Mobile:                  

Email:    

Address:  

Suburb:   

Emergency Contact:                                    

Phone:

Details of the 2nd person

Name:           

Phone:                

Mobile:                  

Email:    

Address:  

Suburb:   

Emergency Contact:                                    

Phone:

 

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I choose the following ticket:

Names of the 8,9,10,11, other people:

 

                             
                    

 I want separate seating for the men and women: yes  no


  ----------------------------------------------------------------------------------------------------  

 

Payment Information

Name on card:           

Credit card number:     

Expiry date (dd/mm):

 

I would like to give an extra donation of  to DaMinyan

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(There is a 3% surcharge for American Express payments.) 

 

 

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