RSVP

Director: $10,000 − 20 Tickets Benefactor: $1,000 − 4 Tickets
Associate: $5,000 − 16 Tickets Patron: $500 − 2 Tickets
Underwriter: $3,000 − 10 Tickets Individual / Couple Tickets
Individual $125   Couple $250
I am unable to attend, but I would like to make a contribution of $

Please reserve your tickets below. Donations to Lake Regional Hospital Auxiliary are tax deductible.

Ten guests will be seated at each table. Please indicate seating requests in the space below.

Please reply by Friday, September 21st.

Name
Address
Telephone
City
State
ZIP
List additional names:

For information, call 573-348-8264.