6th Annual Marc Sargis Memorial  
 

Dinner-Only Registration Form

 

Please provide the following information and send this form and payment to the address listed below.

-Forms received without proper payment will not be honored-

-Checks and Money Orders ONLY-

 

Name:

Address:

City:

State:

Zip:

Phone:

E-Mail:

             

 

Please circle the Number of people you wish to register:

 

1 Person             2 People             3 People             4 People

($75)                   ($150)                 ($225)                 ($300)

 

Please provide the people(s) names:

Person 1:

Person 2:

Person 3:

Person 4:

Total:

$

 

 

 

 

 

Please Make Checks Payable To:

Marc Sargis Memorial Fund

 

 

Send completed form and payment to:

 

Marc Sargis Memorial Fund

c/o Ray sargis

1633 Courtland Ave
Park Ridge, IL 60068

 

No One Registered Until payment is received

ALL PAYMENTS MUST BE RECEIVED BY MAY 15th 2010

Thank You.