I would like to attend the Rudy Vallet Memorial Dinner

Print and fill out.

Please reserve ______ individual tickets at $45 each.

I am unable to attend, but would like to contribute $____________.

Enclosed is my check for $__________.

Name______________________________________________________________________

Address____________________________________________________________________

State _____________________ Zip _________________

Phone _________________________________________

Email__________________________________________

Please send this sheet with your check made payable to SPARC to:

SPARC, Box 90, Blooming Grove, NY 109 14

Phone and/or email is necessary, so that we can confirm your reservation.

Your ticket will be held at the door the night of the event.

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