20th Anniversary NCCAR Dinner – Response coupon

Tuesday January 31st 2006, 6:00pm

Crowne Plaza Hotel

  101  Lyon Street , Ottawa

 

Number of tickets @ $200 per ticket ($150 for members only)     ________ = $_________

 

Number of tickets @ $70  per ticket (valid ID)                             ________ = $_________

 

Number of tables @ $1,400 per table                                           ________ = $_________

                Tables include 8 tickets, Name of the company on the table

 

Official sponsorship @ $1,000 per package                                   ________ = $_________

                Name of the company on the program, Name of the company on a sign at the entrance

 

Do you require vegetarian meals _________  if  yes number _________.

 

Do you require a non-alcoholic table _________.

 

A portion of the cost of your ticket is tax deductible

 

PAYMENT BY CREDIT CARD CAN BE MADE:  Please fill in the information.

 

Name on the credit card:    _________________________________________________

 

Bin number (slightly above or below the embossed card number):            ____________

 

Credit card number:           _________________________________________________

 

Date of expiry:                      _________________________________________________

 

Address:                                _________________________________________________

 

                                                _________________________________________________

 

                                                _________________________________________________

 

Telephone number:             __________________________________________________

 

Type of Credit Card (Visa, MasterCard): ______________________________________

 

Cheque payment can be made for the whole amount and paid to "NCCAR. Make a note on the
chqeue that it is for the "NCCAR Dinner"

 

SEND THIS RESPONSE COUPON AND PAYMENT TO:

NCCAR, Suite 301 63 Sparks Street, Ottawa , ON – K1P 5A6

Or Fax to: 613-235-9185

 

________________________________________________

 

Name of Company:                  _________________________________________________

 

Address:                                  _________________________________________________

 

                                                _________________________________________________

 

Telephone, fax & email:           __________________________________________________

 

                                                _________________________________________________