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


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