Fashion Show Reservation
Date: Tuesday, September 18, 2012
Time: 11:00 a.m. - Reception and Raffle
12:00 p.m. - Lunch and Fashion Show		Location:Hyatt Regency Cincinnati
I will purchase an individual ticket at the following level and I will invite friends.
(Select one):
QTY: $
I will purchase a table of 10 at the following level.
(Select one):
QTY: $
I am unable to attend, please accept a donation in the amount of $ in support of the event.
I would like to purchase raffle tickets - $25 for 1 or $100 per 5.
(Select one):
Total:

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

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




Submit Form by September 10, 2012
Fax to DfSC: (513) 651-3376
OR
Mail To:
Dress for Success Cincinnati
135 West 4th Street
Cincinnati, Ohio 45202

Payment Method: