Please print and complete the following form
| Name: ___________________ |
Organization: _________________________________ |
|
| Address: _____________________________________________________________ |
| Email: _______________________________________________________________ |
| City/State/Zip: _________________________________________________________ |
| Phone (daytime/evening): _________________________________________________ |
Note:
Orders will be processed in the order they are received and
as space permits. To avoid the possibility of being closed
out, please indicate your evening preferences (first through
fourth choices)
| Priority |
|
(circle one)
AA |
A |
B |
Qty.=Total |
| _____ |
Thursday, December 13, 2012, 7:00pm |
$50 |
$40 |
$35 |
x_____ = $______ |
| _____ |
Friday, December 14, 2012, 7:00pm |
$50 |
$40 |
$35 |
x_____ = $______ |
| _____ |
Saturday, December 15, 2012, 7:00pm |
$50 |
$40 |
$35 |
x_____ = $______ |
| _____ |
Sunday, December 16, 2012, 5:00pm |
$50 |
$40 |
$35 |
x_____ = $______ |
Wine List
| |
|
Qty. |
| Cabernet-Merlot Blend |
$19.50/bottle |
x_____ = $______ |
| White Zinfandel |
$19.50/bottle |
x_____ = $______ |
| Chardonnay |
$19.50/bottle |
x_____ = $______ |
| Non Alcoholic Wine |
$12.00/bottle |
x_____ = $______ |
|
+ Service fee |
$ 1.50 |
|
Total Due |
= $______ |
| Method of payment:(Please circle one.) |
|
| Check(Payable to WSU Madrigal Dinner) Credit/Debit |
|
| *For payment by credit or debit, please call the Box Office at (937) 775-554. |
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| Send a brochure to a friend: |
|
| Name_____________________________________________________ |
|
| Address___________________________________________________ |
|
| City/State/Zip________________________________________________ |
|
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