2017 QCESC Banquet Pre-Registration for Display or Silent Auction
Organizations or individuals wishing to have a display during the social hour and/or donate an item for the silent auction need to fill out this form and submit. With the social scheduled from 5:00 - 6:30 PM, you need to be setup no later than 4:45 PM.

The event is being held at the Putnam Museum & Science Center, 1717 W 12th St, Davenport,

Any further questions on displays should be sent to Jeffrey Richland, QCESC Director via e-mail at Jeffrey.richland@gmail.com or phone at 563-336-3822

Any further questions on the silent auction should be sent to Jeffrey Lanum, QCESC Fund Raising Chair at: jlanum@electricdoctor.com.

Note: You must fill out all of the mandatory fields as indicated by a symbol * at the end of the field name (example Your Full Name *) for the form to ave saved and submitted.

Your Full Name *
(Example John Smith)
Your answer
Your E-mail Address *
Your answer
Phone Number (cell phone if available) *
(format XXX-XXX-XXX - would only use if can't reach by e-mail)
Your answer
Organization you Represent or None *
Your answer
What woud you like to support / request? *
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