2008 Gala & Nurse Recognition Reservation

PLEASE PRINT

Name: _____________________________________________________________

Address: _____________________________________________________________________
(Street) (City) (State) (Zip)

Day Phone: ( ) __________________________ Email: ____________________________

Please reserve _________ ticket(s) at $75 per person *
Please reserve _________ tables(s) at $750 per table *
* Personalized place cards are made for table assignments. Please provide individual names for all ticket holders. Print names on reserve side of this form or attach a separate sheet.

_____ Enclosed please find my check payable to “NJLN” for $ _______.

_____ I am unable to attend but would like to make a contribution of $ ______.

_____ Please charge $ ______ to the following credit card:

(   ) Visa (   ) Mastercard (   ) American Express

Account #: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp: _____________
Security # on back of card: _______
Name on Card: ____________________________Signature: ______________________

Credit Card reservations may be Faxed to NJLN at 908-789-0727
NJLN Office: 908-789-3398 Email: NJLNurse@aol.com

(All contribution are tax deductible as allowed by law.)

PLEASE RSVP BY OCTOBER 15, 2008




Proceeds to Benefit...
The New Jersey League for Nursing which is dedicated to advancing the promotion of quality health care through the collaborative efforts of nurses, consumers and other providers of health care. All contributions are tax-deductible as allowed by law.