2009 Fundraising for Health and Rescue Reservation Form
Friday October 16, 2009
Name of person making reservation:______________________________
Address: ________________________________________________
City: ____________________________________________________
State: ___________________ Zip: ________________________
Phone: ______________________ Cell: ______________________
Email: ____________________________________________________
Buffet Style Meal
Cost per person: $30.00 # of reservations X $30.00 = Total amount enclosed $________________ USD
Tables will accommodate ten (10) people. Please list below the names of each person you are paying for.
Payment in FULL must accompany this reservation form, Payable to DPCA
Payment must be made in US Funds and drawn on a US bank. There will be a $25.00 service charge for any check not honored by the bank.
Mail reservation form with check or money order to:
Robin Kelley,
17 George St.,
Framingham, MA 01702 USA
Mail Deadline for Reservations is September 25, 2009. Reservations can be made AT the National,
but 9/25 is the deadline for reservations to be MAILED in so they arrive before Robin leaves.
Person(s) Paying For:
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