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Fairfax Federation Citizen of the Year Banquet RSVP for 2 April 2017
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 $ 65 Chicken Swordfish Vegetarian
2 $130 Chicken Swordfish Vegetarian
3 $195 Chicken Swordfish Vegetarian
4 $260 Chicken Swordfish Vegetarian
5 $325 Chicken Swordfish Vegetarian
6 $390 Chicken Swordfish Vegetarian
7 $455 Chicken Swordfish Vegetarian
8 $520 Chicken Swordfish Vegetarian
9 $585 Chicken Swordfish Vegetarian
10 $650 Chicken Swordfish Vegetarian
 1. With which recipient's group would you prefer to be seated? Joseph Chudzik Cheryl Ellsworth Emily McCoy Ken Balbuena 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 29 March, 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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Fairfax County Federation of Citizens Associations, P.O. Box 3913, Merrifield, VA 22116-3913
2005 - FCFCA;
http://www.FairfaxFederation.org FedWebmaster2017%20@%20fairfaxfederation.org