REGISTRATION FORM FOR
A MAGICAL EVENING

 MONDAY, SEPTEMBER 24, 2012

Guest Information
Submitter's E-mail Address
Company Name
Name(s) of each guest(s)  
Address
City
Province
Postal Code
Home Phone
Work Phone
Received Invitation From
   
Your Ticket Details

Magic Sponsor   $2500                 Amount:
1 Table 8 persons

4 Tickets   @$700                        Amount:

How many individual tickets @ $200 each?






   
Total Event Amount                             $
   
Name on Official Tax Receipt
   

Select your Payment Option      Credit Card      Cheque    (Make cheque payable to Unity for Autism)

Credit Card Type Visa    Mastercard   
     
Credit Card Number  
Expiry Date Month   Year  
     
Cardholder Name  
 
PRINT A COPY OF THIS SCREEN BEFORE SUBMITTING ON-LINE REGISTRATION
(Do a right click and then print)

  


Unity for Autism
P.O. BOX 38066
550 EGLINTON AVE. WEST
TORONTO, ON M5N 3A8
  Charitable Registration # 85601 0707 RR001

Telephone: (416) 782-4666       e-mail: events@unityforautism.ca