Media dinner registration form

Media dinner registration form

Media Organization Dinner Registration
Step 1: Enter Contact Information
Media Organization?
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Step 2: Payment Information

Credit Card Payment

How many TOTAL attendees?

Select the total number of attendees, including yourself.

$250.00 Number of Guest(s)?

Total

Credit Card

If you need to pay by check...
- include a note with the number of tickets your are purchasing ($250/ea) and the total amount of the enclosed.
- Starting with yourself, include a list of names of all attendees and their entree choice—Filet Mignon or Roasted Branzino).
Make check out and mail to:

Silurians Press Club
P.O. Box 2045
Grand Central Station
New York, NY 10163

IMPORTANT: The deadline for receiving checks is Tuesday, June 9. Payments will not be accepted at the door.

Dinner queries? click to email Dinner Chair Fran Carpentier, or phone, 646-232-3917.
Awards queries? click to email Awards Chair Allan Dodds Frank.
Should be Empty: