CLICK ON BARACK OBAMA IMAGE ABOVE FOR LINK TO PRINTED INVITE & MAIL-IN REGISTRATION FORM

Dinner Registration

* First Name

* Last Name

* Street Address

Address Line 2

* City

* State

* Zip Code

* Phone Number

* Email Address

DINNER SELECTIONS

-Tenderloin of Beef with a Cabernet Reduction & Grilled Polenta
-Garden Herb Crusted Chicken Breast with Fresh Summer Vegetables
-Fresh Vegetable Lasagna

* Person 1 Dinner Choice

* Dinner 1: First Name

* Dinner 1: Last Name

Person 2 Dinner Choice

Dinner 2: First Name

Dinner 2 Last Name

Person 3 Dinner Choice

Dinner 3: First Name

Dinner 3: Last Name

Person 4 Dinner Choice

Dinner 4: First Name

Dinner 4 Last Name

CHECK OUT FOR DINNERS

* Please Chech Number of Persons Attending Dinner

1 Person For Dinner $30.00

2 Persons For Dinner $60.00

3 Persons For Dinner $90.00

4 Persons For Dinner $120.00

I cannot Attend Dinner, but I wish to Donate to HQ

* Indicates Response Required