VFL Impact Award Ceremony Contact Information Organization Name: Name:*FirstLast E-mail:* Phone:* Area Code - Phone Number IMPACT AWARD CEREMONYWho will be attending the Impact Award Ceremony to accept the award? Name 1:FirstLast Name 2:FirstLast Name 3:FirstLast I will not attend the Impact Award Ceremony. (SKIP TO LUNCHEON RSVP) Would you like a VIP guest to acompany you on stage to accept your award? (limit one)*NoYes*** VIP guests are executives, managers, pastors or other highlevel representatives from your organization. ***A VIP guest is NOT required. VIP Guest:FirstLast VIP Guest Title:VALENTINES FOR LIFE LUNCHEON - Main EventRegistration Fee: $10 per attendeePlease note: each table seats TEN.For more than ten attendees, please complete the registration form multiple times as needed.If you have any questions regarding payment ,please email dgotcher@vitalant.org or call 480-675-5642.Please only choose one of the payment options below. # of Attendees:*OneTwoThreeFourFiveSixSevenEightNineTen Payment Method:*Pay Online Via Credit CardMail a CheckSponsor/VIPOutside Maricopa County (No Charge) PAY VIA CREDIT CARD: Leave blank if using another methodSelect OneOne ................$10Two ................$20Three .............$30Four ...............$40Five ................$50Six ..................$60Seven ............$70Eight ..............$80Nine ...............$90Ten ...............$100Make checks payable to VitalantMAIL BY FEB. 1 TO: Vitalant - Valentines for Life6220 E. Oak StreetScottsdale, AZ 85257Attendee InformationPlease list the names of all event attendees. Attendee 1*FirstLast Attendee 2FirstLast Attendee 3FirstLast Attendee 4FirstLast Attendee 5FirstLast Attendee 6FirstLast Attendee 7FirstLast Attendee 8FirstLast Attendee 9FirstLast Attendee 10FirstLastDIETARY RESTRICTIONSPlease indicate the # of members in your group who have special dietary needs.Servers at each table will be able to provide them with alternate options as longas needs are expressed in advance. Full Menu Below Vegetarian Vegan Glutten Free No Dairy No NutsOtherTotal: 0/10Register for the EventReset
Valentines for Life Registration Contact Information Organization Name: Name:*FirstLast E-mail:* Phone:* Area Code - Phone Number Registration Fee: $10 per attendeePlease note: each table seats TEN.For more than ten attendees, please complete the registration form multiple times as needed.If you have any questions regarding payment ,please call 480-675-5460Please only choose one of the payment options below. # of Attendees:*OneTwoThreeFourFiveSixSevenEightNineTen Payment Method:*Pay Online Via Credit CardMail a CheckSponsor/VIPOutside Maricopa County (No Charge) PAY VIA CREDIT CARD: Leave blank if using another methodSelect OneOne ................$10Two ................$20Three .............$30Four ...............$40Five ................$50Six ..................$60Seven ............$70Eight ..............$80Nine ...............$90Ten ...............$100Make checks payable to VitalantMAIL BY FEB. 1 TO: Vitalant - Valentines for Life6220 E. Oak StreetScottsdale, AZ 85257Attendee InformationPlease list the names of all event attendees. Attendee 1*FirstLast Attendee 2FirstLast Attendee 3FirstLast Attendee 4FirstLast Attendee 5FirstLast Attendee 6FirstLast Attendee 7FirstLast Attendee 8FirstLast Attendee 9FirstLast Attendee 10FirstLastDIETARY RESTRICTIONSPlease indicate the # of members in your group who have special dietary needs. Servers at each table will be able to provide them with alternate options as long as needs are expressed in advance. Full Menu Below Vegetarian Vegan Glutten Free No Dairy No NutsOtherTotal: 0/10Register for the EventReset