Virginia Airborne Search & Rescue Squad
Inaugural Gala Registration & Response Card
Name: _________________________________
Address: _______________________________
City: _____________ State: ______ Zip: ______
Tel: ______________ Email: ________________
_____ Individual Seats $150 each
_____ Couples Package $250 per couple
_____ Table Sponsor $1,250 for table of 10 seats
_____ I cannot attend
but please accept my donation of $__________
$___________ Total Enclosed
_____ Please contact me, I’m interested in being
an event sponsor or
donating a silent auction item.
Payment Enclosed: Check __________
CC ________________________ Exp: _______ CID: _____
Kindly respond by May 1, 2012
