Rotary Event: PolioPlus Gala  (Black Tie Optional)

Featured Speaker:   Rotary International President Barry Rassin                                                                              

Reservation Deadline: Friday, October 5, 2018

Place      Mayfair Farms, 481 Eagle Rock Avenue, West Orange,

New Jersey 07052

 

Reservations for Dinner – 6:00 PM

(Includes Pre-Dinner Open Bar Cocktail Reception)

 

______# of reservations @$90 each for a total of $______

 

Name of person making reservation (Please Print) __________________________________________

 

Email Address ___________________________________ Phone # ____________________________

 

If you are a member, please print name of Rotary Club_______________________________________

 

Indicate #: __________ Chicken     __________ Fish ____________ Vegetarian

 

Please print Dinner Reception on check memo (If paying by credit card, go to www.njrotary.org)

 

Reservations for VIP Open Bar Cocktail Reception – 6:00 PM

($1,000 Donors who will receive a Paul Harris Fellow and a Photograph with RI President)

(Spouses of Donors may Attend)

 

Please print all information:

 

Name of Person(s) Attending the VIP Reception _______________________________________________

 

Email Address of Person(s) Attending the VIP Reception _________________________________________

 

Paul Harris Fellow Recipient, if Different _____________________________________________________

 

Name of Recipient’s Club _________________________________

 

Recipient’s Rotary Membership Number (if applicable)  __________________________________

 

Please print VIP Cocktail Reception on check memo (Payment by check only)

 

Make check(s) payable to:  Rotary Club of West Orange Foundation

Mail to:   Monte Ehrenkranz, Event Treasurer

Regal Bank

570 W. Mt. Pleasant Avenue

Livingston, NJ 07039