Rotary Club's Date Night Order Form

Date Night Order Form
Full Name *

First Name Last Name
E-mail *
Phone Number *

Area Code Phone Number
Are you able to pick up your order from Crossroads Restaurant? *

Yes No
Choose Your Gourmet Take-Out Time

4:00 pm 4:30 pm 5:00 pm 5:30 pm
For those unable to pick-up, volunteer Rotarians will deliver. Please provide your address.

Street Address

Street Address Line 2

Town
Order
Date Night Menu

Spring Salad Locally gathered greens with oven roasted tomatoes, olives, roasted peppers, red onions, toasted pine nuts and goats cheese. Drizzled with balsamic dressing, topped with local sprouts.

Grilled strip loin of beef with spring vegetables, roasted potatoes, cipollini onions & finished with a port wine reduction.

Or

Roasted chicken with mango corn salsa, spring vegetables and tomato risotto.

Triple Berry Gallete with cream fraiche.

White OR Red Wine. A full bottle for two diners, or a half bottle for one.

Fresh flowers in a Mason Jar

My Products

1 Dinner Ticket $ 100.00 CAD

2 Dinner Tickets $ 200.00 CAD

Total $ 0.00 CAD

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Please select your main course: *

Grilled strip loin of beef Roasted chicken
Please select a main course for the other ticket holder:

Grilled strip loin of beef Roasted chicken
Please select your wine: *

White Wine Red Wine
Verification *
THANK YOU FOR YOUR ORDER & SUPPORTING ROTARY CLUB PARRY SOUND!
Should be Empty: