inSIGHT Card Party • March 24, 2023

My table is already registered and I would like to payMy table is not registered and I would like to join the waitlist

Prefix*

First Name*

Last Name*

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Community Name (if applicable):

Phone*

YESNONOT SURE?

$50 per year$100 per year$250 per yearNot at this time

Membership Donation

BridgeCanastaMah Jongg

Lunch Only

I am a single and would like you to put me at a tableI have a partner and would like you to pair usI have my table of 4 - 6 players

Note: If you have multiple tables please submit multiple forms.

How many tables of 4 to 6 people are you requesting?:

Please list the other players at your table (players 5 and 6 are optional):*

Cards Table 1

Please list the players at your SECOND table (players 5 and 6 are optional):*

Cards Table 2

Cards Amount (a)

Please list the players at your THIRD table (players 5 and 6 are optional):*

Please list the other players at your table:*

Player 1 (YOU) $135Players 1 & 2 $270Lunch

Total Amount to be Paid Calculation:

Total Amount to be Paid

Credit CardCheck

NOTE: We ask that all payments for your table be received within 7 days of submitting this reservation form.

Any comments or questions?

or email:ruth.bell@insightthrougheducation.org

If paying by check:

Please make check payable to inSIGHT Through Education, Inc.
On the memo line please indicate Card Party

Please mail your check to:

inSIGHT Through Education, Inc.
P. O. Box 33054
Palm Beach Gardens, FL 33420

For assistance with this form please contact:ruth.bell@insightthrougheducation.org

Date

Waitlist Request