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MSMBC 100th ANNIVERSARY GALA REGISTRATION FORM
July 14, 2018 - 5:00 - 8:00 PM, Embassy Suites Grand Ballroom
Adult Ticket Price - $32.00 - Choose "Herbal Chicken Breast (HCB)" or Cedar Plank Salmon (CPS)"
Children Ticket Price - $17.00 (Child age 10 and under) (the Child's entree meat is chicken nuggets)
If you want an adult plate for a child, list them as an Adult

Please note, Registration is not complete until payment is provided to the church.
Email address *
Charolette Leach
Theo McCullom *
Food Option *
Required
Adult Name 2
Food Option
Adult Name 3
Food Option
Adult Name 4
Food Option
Adult Name 5
Food Option
Child Name 1
Child Name 2
Child Name 3
Child Name 4
Child Name 5
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