2010 Shelter Gala Registration

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A Walk to Remember

Saturday May 1, 2010

Holiday Inn, Willmar, MN

Deadline: April 14th

NO TICKETS WILL BE ISSUED

(Note: Enter your email address below. Acknowledgment of

your registration will be sent to you by email.)

Yes, I would like to attend. Please reserve seats at $40/person.

I will pay a total of $

I would like to sponsor a seat for a Shelter House resident. Enclosed is $40

I am unable to attend but wish to make a donation to Shelter House. Inc.

Enclosed is my gift of $

Entree Information:

Herb Encrusted Walleye
Saltimbocca Chicken (chicken breast topped with gouda cheese and stuffed with prosciutto and artichoke hearts)
Vegetarian ~Linguini Primavera

*Items 1 and 2 are served with Caesar salad, boiled baby red potatoes, and fresh steamed vegetables

Atendees:

Name: Entree:

Name: Entree:
Name: Entree:
Name: Entree:
Name: Entree:

(Note: If you want to pay for more than five attendees, you will need to complete this registrationform more than once. You can add the total amount of tickets and extra gifts and pay that amount with one credit card payment.)

Name:
Address::
City:
State:
Zip Code:
Home Phone:
Email:
*Table Host:

*Note about Table Hosts: Some attendees may wish to have a group of up to eight people sit together. If this applies to your group, identify the table host for your group/table and enter his/her name in the Table Host registration blank. At the Gala, Name Cards for all attendees on this registration submission will be placed at the table that corresponds to the designated Table Host. If you need to submit this registration form more than once because you have more than five people in your group, you should identify the Table Host on each registration form you submit. If you are part of a group that is larger than eight people, you will need to designate one Table Host for each full or partial table that people in your group will occupy.

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In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Ave. SW, Washington, D.C. 20250-9410 or call 202--720-5964 (voice and TDD). USDA is an equal opportunity provider and employer.