October Wednesday Night Dinner Reservation
If the reservations for your family are the same for each week, use one form. If not, fill out one form per person.
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I'd like to make a reservation for: (check all that apply)
October 6 - Baked Chicken, Rice & Gravy, Cabbage, Cornbread, Dessert, Drinks
October 20 - Ham, Mac & Cheese, Green Beans, Biscuits, Dessert, Drinks
October 27 - Chili, Fries, Salad, Cornbread, Dessert, Drinks
I will receive my meal by:
Pick up and I am willing to deliver to someone else
Please arrange for my meal(s) to be delivered
If splitting between eat in and pick up, indicate below the number of each.
Number of adult meals needed (11-64 years old) ($7)
Number of children or senior meals (4-10 yrs or 65+) ($5) Family max $22
How will you pay for your meals?
I will pay online at
I will mail a check to P. O. Box 541, Zip 39818
I will bring payment to the office.
I will pay each week at the door. (exact change or check please)
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