A Just Harvest Secure Event Registration Form


14th Annual Awards Dinner
Setting a New Foundation and Restoring Community
Wednesday, October 18, 2017
Mayne Stage
1328 W. Morse Avenue
Chicago, IL 60626

6:00 Cocktail reception with passed hors d’oeuvres and open bar 7:00 Dinner,
followed by program and presentation of awards

$150 per person Valet Parking is available for $10

Sponsorship opportunities are available and listed on reply card. Please contact jan@ajustharvest.org, visit www.ajustharvest.org, or call Jan Hubbard at 773.262.2297 for more information.


Dinner tickets at $150 per person. .00
I am unable to attend; however, I would like to donate to support. .00
Total amount .00

Please list the names of people attending: (Optional)

*First Name:   *Last Name:  
*Address 1:   Address 2:  
*City:   *State:  
*Zip Code:   *E-mail:  
*Daytime Phone#:   *Evening Phone#:  

Company Name (If applicable):



*Payment Type:   Credit Card   Check 

If by Credit Card:

If by Check:
*Credit Card Type:
*Credit Card # :
*Routing # :
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*Exp. Date: /
*Checking Account #:
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After ensuring that all of the information above is correct,
please click the Submit Form Now button ONLY ONCE.
Multiple clicks of the Submit button will result in duplicate charges to your account.
An email confirmation will be sent to the email address you provided.

 


  
A Just Harvest
PO Box 608033 • Chicago, IL 60626 • Phone: 773-262-2297
Send us an e-mailwww.ajustharvest.org


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