REGISTER HERE!
RSVP by Wednesday, February 8

EVENT DETAILS:
Friday, February 17, 2017
JW Marriott Desert Ridge
Grand Canyon Ballroom
5350 E. Marriott Drive, Phoenix AZ 85054
Presented by:

Contact Information

Organization Name:
Name:*
E-mail:*
Phone:*
-

Registration Fee: $10 per attendee

Please note: event will be seated as TABLES OF TEN. 
For more than ten attendees, please complete the registration form multiple times as needed.

If you have any questions regarding payment ,
please call 480-675-5642

Please only choose one of the payment options below.

Number of Attendees:*
Payment Method:*
PAY VIA CREDIT CARD (Indicate # of Attendees): ** leave blank if not using this payment method**

Make checks payable to United Blood Services
MAIL BY FEB. 8 TO: 

Valentines for Life
6220 E. Oak Street
Scottsdale, AZ 85257

Attendee Information

Please list the names of all event attendees.

Attendee 1*
Attendee 2
Attendee 3
Attendee 4
Attendee 5
Attendee 6
Attendee 7
Attendee 8
Attendee 9
Attendee 10

DIETARY RESTRICTIONS

(Please 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
Total: 0/10

EVENT MENU

(If there is any item below you’d like to exclude, please inform your server on the day of the event.)

Roasted Winter Squash Salad:
Spiced Butternut Squash, Roquefort Cheese, Baby Kale, Candied Hazelnuts, Shaved French Black Truffles and White Balsamic Vinaigrette

Entrée:
Herb Roasted Chicken with Robuchon Pomme Purée
Burgundy Jus
French Green Beans

Dessert:
Vanilla Crème Brulee with Fresh Seasonal Berries
& a Chocolate Madeleine