|
CASA
OF SONOMA COUNTY
HEARTS FOR CHILDREN ORDER FORM |
||
| Please print out and complete this order form and fax or mail it with your payment to "CASA." Our address is P.O. Box 1418, Kenwood, CA 95452 and our fax is 707-565-6379. Questions? Call 707-565-6375. | ||
| [ ] | Yes! I would like to attend. | |
| Please
send me ___ tickets @ $100/per
person.
Include names of all
your guests, and their phone
numbers (required). Please print
legibly. |
$ .00
|
|
| Guest Name: Guest Telephone #: | ||
| Guest Name: Guest Telephone #: | ||
| Guest Name: Guest Telephone #: | ||
| Guest Name: Guest Telephone #: | ||
| Guest Name: Guest Telephone #: | ||
| Guest Name: Guest Telephone #: | ||
| Guest Name: Guest Telephone #: | ||
| Guest Name: Guest Telephone #: | ||
| Guest Name: Guest Telephone #: | ||
| Guest Name: Guest Telephone #: | ||
| [ ] | Yes! Please schedule a limo for me or my group. ($500) | $ .00 |
| [ ] | Yes! I/we would like to become a Corporate Sponsor. |
|
| ___ Golden Stars Sponsor ($5,000+) |
$ .00
|
|
|
||
| ___ Silver Lining Sponsor ($2,500-$4,999) |
$ .00
|
|
|
||
| ___ Bronze Wishes Sponsor ($1,000-$2,499) |
$ .00
|
|
|
||
| [ ] | Yes! I would like to contribute items for the auction. | |
| Please have someone from CASA contact me to make arrangements. |
||
| [ ] | I am unable to attend, however I would like to make a contribution of: |
$ .00
|
| [ ] | I am interested in becoming a CASA volunteer. | |
| Please have someone from CASA contact me. | ||
|
TOTAL:
|
$ .00
|
|
|
Credit Card Information
|
||
| Credit Card Type: _______________________________________________ | ||
| Credit Card Number: _______________________________________________ | ||
| # Code on Card : _______________________________________________ | ||
| Expiration Date: _______________________________________________ | ||
| Name on Card: _______________________________________________ | ||
| Amount to Charge: _______________________________________________ | ||
| Authorized Signature: _______________________________________________ | ||
| Signature Date: _______________________________________________ | ||
|
Your Information
|
||
| Name: _______________________________________________ | ||
| Address: _______________________________________________ | ||
| Address: _______________________________________________ | ||
| City, State, Zip: _______________________________________________ | ||
| Telephone (Day): _______________________________________________ | ||
| Telephone(Eve): _______________________________________________ | ||
| Email: _______________________________________________ | ||