Fashion Show Reservation
Date: Tuesday, September 28, 2010
Time: 11:00 a.m. - Reception and Raffle
12:00 p.m. - Lunch and Fashion Show		Location:Hyatt Regency Cincinnati
Yes! I will purchase an individual ticket at the following level and I will invite friends.
(Select one):
 Friend Ticket ($75 each)
Patron Ticket ($150 each)		QTY: $
Yes! I will purchase a table of 10 at the following level.
(Select one):
 Friend Ticket ($750 each)
Patron Ticket ($1,500 each)		 QTY: $
No. I am unable to attend, please accept a donation in the amount of $ in support of the event.
Name as you would like it to appear: First: Last:
Address:
Address 2:
City:
State:
Zip:
Country:
Phone #:
Email Address:
Names of Friends you are Inviting:

Payment:
Check to be mailed in the amount of $ .
Check made payable to 'Dress for Success Cincinnati'.
Charge my credit card in the amount of $ by using PayPal.

Billing:
Name:
Address:
City:
State:
Zip:
Country:
Phone Number:
Email Address:

My payment will be sent with invitation reservation form at a later date.


Submit Form by September 14, 2010
Fax to DfSC: (513) 651-3376
OR
Mail To:
Dress for Success Cincinnati
135 West 4th Street
Cincinnati, Ohio 45202

Payment Method: