Valentine Banquet Registration Form

WAYS YOU CAN REGISTER:

Be a table sponsor.
Purchase couples tickets.
Purchase individual tickets.
Give additional funds towards door prizes.
Donate Valentine Banquet related door prizes.

Dinner will include door prizes.

ATTENTION: We are already 95% SOLD OUT for this event!

We have NO table sponsorships available. We only have 3 Couple & 6 Individual tickets available.

10th Annual Valentine Banquet Registration: SELLING OUT FAST!

"*" indicates required fields

Partners & Friends

Thank You For Your Generous Contribution!

Please fill out this form in its entirety.

Please purchase your tickets by January 10, 2025 to reserve your seat. Tickets will go on sale to the general public on December 13, 2024. To reserve your seat or be a door prize sponsor contact Pam Santiago, Office Manager, at (717) 304-3291 or officemanager@restartministry.org. ALL SALES FINAL. No changes are permitted after the early registration deadline: January 10, 2025. Also note, table sponsorship and ticket prices will increase after the early registration deadline on January 10, 2025.

Check all the options below that apply to you:*

Yes, I would like to register and purchase couples tickets ($125 per couple).

Yes, I would like to register and purchase individual tickets ($65 per ticket).

I would like to donate money towards door prizes.

I would like to donate door prizes for the event. Please contact me to set up a time to pick up the items I am donating.

I would like to donate toward the mission of Restart.

I am unable to attend the event.

Couples Tickets *

Please note how many couples tickets you'd like to purchase. Price is per couple. If none, please enter "0".

Price: $125.00

Individual Tickets *

Please note how many individual tickets you'd like to purchase. Price is per individual. If none, please enter "0".

Price: $65.00

Number of tickets for children ages 4-10*

Number of tickets for children ages 1-3*

Number of guests in your party:*

Donation Towards Door Prizes:*

Donated Door Prizes for the event are valued at:*

The door prizes I wish to donate are*

Donation Towards Mission of Restart:*

Name*

First Last

Business Name*

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Do you have a website?*

Yes

Business/Organization Website*

Questions?

If you have any questions, please contact RTCM Office Manager Pam Santiago at 717-304-3291 or via email at officemanager@restartministry.org. The official registration and financial information of Restart Training Center Ministry, Inc. may be obtained from the Pennsylvania Department of State by calling toll free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement.

Total Contribution:

This field is for validation purposes and should be left unchanged.

6768813347

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