HPJC Peacemaker Awards Dinner Reservation Form

Make Your Reservations Here for HPJC's

Peacemaker Awards Dinner

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Gather with old friends & new to celebrate the 2022 Peacemaker Awardees:

Reuben Jonathan Miller

Drs. Maria Elena Bottazzi and Peter Hotez

Rep. Senfronia Thompson

Lenore Walker

Saturday, Nov. 12, 2022

Check-In, Social Hour, Cash Bar 5:00-6:30 PM

Dinner & Program begin at 6:30 PM

Marriott Houston South-Hobby
9100 Gulf Freeway, Houston 77017

Reservation DEADLINE: Nov. 3

Ticket prices:

$80 through Sep. 14

$90 Sep. 15 - Oct. 12

$100 Oct. 13 - Nov. 4

All attendees should be fully vaccinated, if possible, for COVID-19.

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More details and updates about the event and Peacemaker awardees are on the

2022 HPJC Awards Dinner Web Page

Attendee Information

Please list below, for yourself and your guests:

First and Last Names
Email addresses
Meal preferences

You can list the first five below, and list any others in the "Additional Information" box at the bottom. We may contact you before the dinner for additional info.

Having email addresses for each will allow us to send updates directly to them.

Note: If you are reserving a table for 10 people (for $1000), be sure to select 10 below where it asks how many dinner reservations you're making - even if you aren't sure yet about all their names. And also check the box further down the form for reserving a table for 10, so we can reserve all the seats at one table for you and your guests.

How many Dinner reservations you are making now?*

Dinner Reservations

How many AFTERNOON RECEPTION reservations are you making now (including people listed above and any TBD's)?

Reception Reservations

1st Attendee (you)*

First NameLast Name

Your meal choice*

Your E-mail*

2nd Attendee

First NameLast Name

2nd attendee meal choice

2nd Attendee's E-mail

example@example.com

3rd Attendee

First NameLast Name

3rd attendee meal choice

3rd Attendee's E-mail

example@example.com

4th Attendee

First NameLast Name

4th attendee meal choice

4th Attendee's E-mail

example@example.com

5th Attendee

First NameLast Name

5th attendee meal choice

5th Attendee's E-mail

example@example.com

If you are making reservations for more than 5 people, please list the names of the additional people and the entree choice for each in the "Additional Information" box at the end of this form.

If any of your dinner attendees have food allergies, please list his/her name along with the type of allergy, in the "Additional Information" box at the end of this form.

Do you want to buy a full table of ten seats for $1000? Thank you for supporting us - you will be mentioned in our program and have an option of having space at an information table before the dinner begins. Please be sure to also specify 10 people at the top of this form, where it asks how many dinner reservations you are making.

YesNo

How would you like your table to be named

Your Phone Number*

Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

AWARDS DINNER SEATING: Most attendees will be free to find seating at the Awards Dinner at any non-reserved tables. If you are making reservations for three or more, we will try to assign you all to the same table. Each table seats a maximum of ten. If you need other seating accommodations, please let us know and we will do our best.

Describe seating accommodations above.

NOTE: The Peacemaker Awards Dinner is HPJC's primary fundraiser for the year, and we depend on extra donations to fund our work.
Please consider giving more than the ticket prices and/or becoming a member of HPJC (or renewing your membership), to support our work for peace and justice, to fund our activities throughout the year, and so that people of slender means can attend at discounted rates.

Extra Donation Amount

Enter dollar amount

If you're making an extra donation amount of at least $200 more than the cost of the dinner(s) to be an underwriter, and/or are getting a table for 10, please list your name(s) here as you want to be listed in the program booklet. Leave blank to be anonymous. Acknowledgements in the program will not indicate donation amounts. THE PROGRAM BOOKLET WILL GO TO PRINT by NOV. 1.

HPJC Membership Selections

Please join HPJC (or renew or gift a membership to HPJC) for $35 per individual or $50 per family, and/or $45 per organization!

Number of HPJC individual memberships at $35 each

Name for each individual membership and the email address of each (if email address is not provided above)

Example entry: Sally Johnson, sjohnson@noemeail.com John Smith, jsmith@noemeail.com

Number of HPJC family memberships at $50 each

Please list names & email addresses (besides you) of the family members getting an HPJC membership

Example entry: Pat & Mark Smith, pmsmith@noemeail.com Tracy & Lynn Jones, jonestl@noemeail.com

Number of organization memberships at $45 each

Please list name(s) of organizations paying for an HPJC membership

Example entry: Organization to Promote Peace

Total Amount Due:

Because of credit/debit card service charges, we prefer that payments $500 or more be made by check, if possible.

Please choose payment method:

checkcredit/debit card

Make checks payable to HPJC, and mail to HPJC, PO Box 66234, Houston, TX 77266-6234, along with a print out of page 2 (which shows your name) of the completed registration form.

HPJC Dinner Total $ Amt

USDHPJC Dinner Total

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

ADDITIONAL INFORMATION:

IMPORTANT: Be sure to click on the "Submit Form" button below to record your registration. Clicking on "Submit Form" will also record your credit/debit card payment, if you chose that payment option.

THANK YOU for your support of HPJC, and we look forward to seeing you at the Peacemaker Awards Dinner!