BalSwan Ball 2010
Ball Registration
Name
Company
Address
City
State
Zip
Phone
Email
Number of tickets
1
2
3
4
5
6
7
8
9
10
x $130 per ticket = $
130
Beef entrees will be served unless a vegetarian meal is requested.
Number of vegetarian meals:
0
1
2
3
4
5
6
7
8
9
10
Please list those attending and anyone you would like to sit with. If responding for a company or
group, list the names of the persons who will be attending. Remember, no tickets will be sent.
Name
Address
Phone
Email
Cost is $100 per person
I would like to donate an additional
Yes, we are interested in participating in the casino games.
Enclosed is $
0
20
40
60
80
100
120
140
160
180
200
500
1000
Every $20 donation increment equals $200 in chips and a raffle ticket. For every $20 donated, $14 is tax deductible.
Payment
MC
Visa
Amex
Discover
Card #
Exp Date
mm/yy
Security Code
Name on Card
Comments