Senior Winter Gala | Gala Anual de Invierno

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Join us on Thursday, December 14, 2023 from 12pm - 4pm for our Annual Winter Senior Gala to be held at Regency Inn Banquets located at 5319 W. Diversey Ave. All guest must RSVP by filling out the form below. If you have any questions, please call 773.292.0202. Each senior (65+) needs to be individually registered. We look forward to celebrating with you all!

Acompáñenos el jueves 14 de diciembre de 2023 de 12pm a 4pm para nuestra Gala Anual de Invierno para Adultos Mayores que se llevará a cabo en Regency Inn Banquets ubicado en 5319 W. Diversey Ave. Todos los invitados deben RSVP completando el siguiente cuestionario. Si tiene alguna pregunta, por favor llame al 773.292.0202. Cada adulto mayor (65+) necesita ser registrado individualmente. ¡Esperamos celebrar con todos ustedes!

First Name

Last Name / Apellido

Address / Dirreción

Phone Number / Número de teléfono

Zip Code / código postal

DOB / Fecha de nacimiento

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of State Senator Omar Aquino.

Does this form look suspicious? Report

Forms