Fairfax Federation 2012 Citizen of the Year Banquet RSVP

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Fairfax Federation 2012 Citizen of the Year Banquet RSVP for 7 April 2013
To pay for your reservation, please either use the PayPal button below or mail a copy of this printed form with a check made payable to FCFCA to:

THE FEDERATION
Attention: Citizen of the Year Banquet
3153 Ramesses Ct
Oak Hill, VA 20171

Please enter your information below, print out a copy for your records (landscape mode) and then click the SUBMIT button below to submit your reservation form.

Submitter: Email address: Phone Number:
Company/Affiliation: Address:
Attendees/Cost	Name	Dinner Choices:
1 $ 65			Sirloin Salmon Vegetarian
2 $130		Sirloin Salmon Vegetarian
3 $195		Sirloin Salmon Vegetarian
4 $260		Sirloin Salmon Vegetarian
5 $325		Sirloin Salmon Vegetarian
6 $390		Sirloin Salmon Vegetarian
7 $455		Sirloin Salmon Vegetarian
8 $520		Sirloin Salmon Vegetarian
9 $585		Sirloin Salmon Vegetarian
10 $650		Sirloin Salmon Vegetarian

1. With which recipient's group would you prefer to be seated? Peter Murphy Rose Chu Phyllis Payne Katherine Hanley Kyle Talente Other No affinity

2. I am unable to attend however I wish to help defray the Fairfax County Citizen of the Year Awards Banquet in the amount of: $

3. If paying by check, please mail a copy of the printed form with your check made payable to FCFCA to THE FEDERATION, Attention: Citizen of the Year Banquet, 3153 Ramesses Ct., Oak Hill, VA 20171.

4. If you are completing this form after April 1st, do not mail your check. After submitting your reservation electronically, please call 703-424-2956 to confirm your reservation and then pay at the banquet registration desk (no credit cards accepted at the banquet).

5. Tickets will be held at door.

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