Winter Gala Dinner Dance Tickets

Order by January 4, 2009   Please print and complete the form. 

Company Name:                                                                                                                                            

Address:                                                                                                                                                         

City:                                                                                                           State:                  Zip:                    

Phone:                                             Email:                                                                                                     

Check:               Visa:                    MC:             Receipt requested:        Fax:                                               

Credit card:                                                                              Exp Date:         /                          

No. Tickets __________  at $95.00 each   Amt. Due: $                                      

1.  Name:                                                                                                                                                        

Circle entrée selection

Filet Mignon & Crab Cake             Filet Mignon only                           Crab Cake only                  Vegetarian

2. Name:                                                                                                                                                         

Circle entrée selection

Filet Mignon & Crab Cake             Filet Mignon only                           Crab Cake only                  Vegetarian

3. Name:                                                                                                                                                         

Circle entrée selection

Filet Mignon & Crab Cake             Filet Mignon only                           Crab Cake only                  Vegetarian

4. Name:                                                                                                                                                         

Circle entrée selection

Filet Mignon & Crab Cake             Filet Mignon only                           Crab Cake only                  Vegetarian

5. Name:                                                                                                                                                         

Circle entrée selection

Filet Mignon & Crab Cake             Filet Mignon only                           Crab Cake only                  Vegetarian

6. Name:                                                                                                                                                         

Circle entrée selection

Filet Mignon & Crab Cake             Filet Mignon only                           Crab Cake only                  Vegetarian

7. Name:                                                                                                                                                         

Circle entrée selection

Filet Mignon & Crab Cake             Filet Mignon only                           Crab Cake only                  Vegetarian

8. Name:                                                                                                                                                         

Circle entrée selection

Filet Mignon & Crab Cake             Filet Mignon only                           Crab Cake only                  Vegetarian

9. Name:                                                                                                                                                         

Circle entrée selection

Filet Mignon & Crab Cake             Filet Mignon only                           Crab Cake only                  Vegetarian

10. Name:                                                                                                                                                       

Circle entrée selection

Filet Mignon & Crab Cake             Filet Mignon only                           Crab Cake only                  Vegetarian

Mail to Carroll County Chamber of Commerce   P.O. Box 871   Westminster, MD 211158 or Fax 410-876-1023