Name
____________________________________________________________________________

Address
___________________________________________________________________________

City State Zip
____________________________________________________________________________

Phone Number
____________________________________________________________________________

Email Address
____________________________________________________________________________

I would like _____ Individual Tickets at $80 each. Please list names of all attendees on reverse.

If a vegetarian meal is desired, please specify the number of meals ______

I am unable to attend, however please accept my tax deductible donation of $_______

*** Please visit cuhumane.org for sponsorship opportunities for this event.

Payment:
______ Check or Money Order for $__________

______ Mastercard ______ VISA ______ Discover

Number ______________________________ Exp _______