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Fairfax Federation Citizen of the Year Banquet RSVP for 15 April 2018
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
P.O. Box 3913
Merrifield, VA 22116-3913
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 $ 55 Chicken Beef Fish Vegetarian
2 $110 Chicken Beef Fish Vegetarian
3 $165 Chicken Beef Fish Vegetarian
4 $220 Chicken Beef Fish Vegetarian
5 $275 Chicken Beef Fish Vegetarian
6 $330 Chicken Beef Fish Vegetarian
7 $385 Chicken Beef Fish Vegetarian
8 $440 Chicken Beef Fish Vegetarian
9 $495 Chicken Beef Fish Vegetarian
10 $550 Chicken Beef Fish Vegetarian
 1. With which recipient's group would you prefer to be seated? Gary Ambrose Barbara Lippa Lyle McLaren Richard Raines Earl L. Flanagan 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. Opportunities to be a sponsor of the Fairfax County Citizen of the Year Awards Banquet are explained here.
 4. 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, P.O. Box 3913, Merrifield, VA 22116-3913.
 5. If you are completing this form after 11 April, do not mail a check, instead pay using PayPal below. After submitting your reservation electronically, please call 703-424-2956 to confirm your reservation (Payments cannot be accepted at the banquet).
 6. Tickets will be held at door.
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