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Company Name: _______________________________________________________
Contact:______________________________________________________________
Title:_____________________ E-Mail:____________________________________
Address:___________________________________________________________
City: _____________________________ State:_________ Zip: ________________
Phone: (____) ____________________ Fax: (____) _________________________
Kings Round Table: $1,500Table of 8, Table sign fit for a King, lavish beads and 2 bottles of wine
Queens Court: $1000Table of 8, Queens Court table sign and special beads
Jesters Quarters: $500Table of 4, Jesters Quarters table sign and fun beads
Signature of Card Holder:_________________________________________
Fax or Mail to the address below
Payment Type (check one): Check___ MC___VISA___AMEX___DISCOVER___
Credit Card No.________________________________ Expiration Date: ____/____
Make Checks Payable to Hospice of the Valley
Saturday, February 13, 2016Mr. Anthony’s Boardman
7440 South AvenueParty Begins at 6:30 PM
OF THE VALLEY
A Sweetheart of a
5190 Market StreetYoungstown, OH 44512
ATTN: Liz McGarry330.788.1992 / Fax: 330.788.1998
Email: [email protected]
Sp
on
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ip F
orm
Mardi GrasPresented by Home Savings
Event Chairs: Denise & John York and Barbara & Frank Hierro
Please enclose the names of the guests at your table.
