MJCHF Annual Fundraising Dinner
Please use this form to make your reservation(s) for this event.

The cost to attend is $200. Seating is available in tables of 10. A portion of your ticket is considered a tax deductible donation. Payment is due no later than March 12, 2019.

 If you have any questions about submitting this form, contact us at (618) 655-2881.

Email address *
Last Name *
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First Name *
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Address *
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Phone Number *
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How many seats total would you like to reserve? *
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Names of guests
Please include the first and last names of each of your guests who will be attending under this reservation.
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Do you or any of your guests have dietary restrictions? *
If you answered yes to the previous question, please list your name/your guests' names and what dietary restrictions they have.
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