2011 Manny Awards Dinner

Thursday, May 19, 2011
5:30 Networking Reception
6:30 Dinner & Program

NUMBER OF TABLES/SEATS
NAMES OF THOSE IN MY PARTY**
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
Additional Names
**Please call with any dietary restrictions
*Company Name
*Contact Name
*Address

*City
*State
*ZIP
Phone:
Fax:
*Email Address:
BILLING INFORMATION:
*First Name
*Last Name
*Address Line 1:
Address Line 2:
*City:
State:
*ZIP code:
PAYMENT INFORMATION:
*Card Number:
*Expiration Date (mm/yy):	-
CONFIRM IDENTITY:
*For security purposes, please enter the code you see below: