Thursday, April 18
5:30 - 7:30 pm
Full Name
*
Address
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Street Address
Street Address Line 2
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State
Zip Code
E-mail
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Phone Number
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Area Code
Phone Number
Tickets
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Individual Tickets
$
20
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Donation
$
40
I cannot attend the event but would like to support Dietert Center Meals on Wheels with my charitable contribution. Donations can also be made through www.dietertcenter.org .
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Total
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Names of Individuals attending for registration purposes:
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Should be Empty: