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Event Registration for 5th Annual Seattle Benefit Dinner on 05-14-2010

Required Information
First Name:  
Last Name:    
Maiden Name: 
Address 1:   Address 2:   
City:   State:   Zip:  
Country: 
Email:   
Home Phone:   Work Phone:  Cell Phone: 

Event Information
# of attendees:  (including yourself)
Please list your name along with any other attendees.   
Attendee First Name:  Last Name:  
Ticket Price: $60.00 per person
Total Ticket Price Due: $60.00
Entree choice: 
Would you like to be contacted regarding sponsorship opportunities? 
Sponsorship Opportunities: 
Do you have any special requests or additional comments? (such as dietary restrictions, seating requirements, etc.):

Additional Information
Your Former Jesuit Volunteer affiliation(s) (if applicable):
1. Dates of JV Service:  to  City, State: 
2. Dates of JV Service:  to  City, State: 
3. Dates of JVC staff or Board service:  to  Position(s): 
Do you know someone else who should be invited to this event ? 
If yes, please include their name and email address:
First Name:  Last Name:  Email: 

Copyright 2007, Jesuit Volunteer Corps Northwest, all rights reserved.
Mailing Address: P.O. Box 3928, Portland, OR 97208
Street Address: 3928 North Williams, Portland, OR 97227
PHONE 503 335 8202 | FAX 503 249 1118
info@jvcnorthwest.org