DINNER RESERVATION

 Dr. Thomas DiLorenzo

Saturday, March 20, 2004
 6:30 p.m. Dinner   8 p.m. Program

 

Name

 

Address

 

City, State, Zip

 

Phone:

 

Cell Phone:

 

E-mail:

 

 

 

 Adults - $17.00/person                                    Adults __________ x  $17.00 = __________

Children under 12 - $10.00 person                   Children_________ x  $10.00 = _________  
             Total Enclosed                          __________

Make cheques payable to Gen. Jubal A. Early Camp 556, SCV and mail to: 
Reservations, General Jubal A. Early Camp 556,  6101 S. 2nd Street, Tampa, FL 33611

IMPORTANT:  Your reservation must be received by Tues., March 16th.  First come, first served.