KEY-ACTION NETWORK

Presents
ANNUAL BENEFIT DINNER IN SUPPORT OF GOOD SHEPHERD CENTRES
Friday October 17, 2014 Liuna Station 360 James Street North Hamilton
Registration:6:00pm Dinner 7:00pm Dance to follow

MUSIC, FOOD AND PRIZES! Music provided by Mr. Productions DJ Services

Tickets

Early Bird Ticket(s) ________ at $75 each=$______________

Full Reserved Table of 10- $700
General Donation of $100 or $_________________
Please invoice me.
Payment by Mastercard, Visa or American Express. (Please Circle)

If purchasing a full table, your company name will be on the card reserving your table.
Your Contact information:
Business Full
Name:_____________________________________________________________________________________________
______________

Contact Person: _______________________________________________________

Company: _____________________________________________________________
Address: ____________________________________________________________
City: ______________________________ Prov: _________ Postal Code: _________

Business Phone: ______________________Business Fax: ___________________

Credit Card Number: ________________________________________________
Expiry Date: _____________/_________ CVC Number on back: ____________________
Tax receipts will be issued within 90 days of the event as the amount will depend on Revenue Canada
allowance. Receipt will be sent to the address above.
Please return form to: Key Action Network Benefit Dinner
U4-444 Stone Church Road West
Hamilton ON L9B 1R1
Fax: (905)390-3582

UNITED IN LOVE, COMPASSION AND CARE FOR ONE ANOTHER