Military Dinner Reservation
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
If not Retired, Please fill out Organization Name and Occupation.
Retired
Business/Organization name
Occupation
Reservation
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Club Sponsor
Eight people per table, Preferred seating, Advertisement 25% discount
$
800.00
Quantity
1
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10
Dinner Ticket
$
100.00
Quantity
1
2
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VIP Reception
VIP Reception and Photo-op with Speakers Only
$
50.00
Quantity
1
2
3
4
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9
10
For check-in purposes, please provide the names of all guests below.
Payment Methods
Debit or Credit Card
Please click one of the PayPal options to complete payment and
submit
the form.
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