Volunteer as a Table Captain

YES! I want to help Medic One Foundation save more lives by volunteering as a Table Captain for the LIGHTS! SIRENS! AUCTION! As a Table Captain, I understand that I will invite friends and associates to attend the evening event, with the goal of filling a table of ten.

*(denotes required field)

Name: *

E-Mail Address: *

Address:

City, State, Zip:

Daytime Phone:

Guest List

Confirmation with event information will be mailed/emailed to all guests if the form is received two weeks before the event. Please identify any guests that prefer a vegetarian dish.

Table Captain - Name:

Address:

City, State, Zip:

Phone:

Email:

Vegetarian:

Yes
No

Guest 2 - Name:

Address:

City, State, Zip:

Phone:

Email:

Vegetarian:

Yes
No

Guest 3 - Name:

Address:

City, State, Zip:

Phone:

Phone:

Email:

Vegetarian:

Yes
No

Guest 4 - Name:

Address:

City, State, Zip:

Phone:

Email:

Vegetarian:

Yes
No

Guest 5 - Name:

Address:

City, State, Zip:

Phone:

Email:

Vegetarian:

Yes
No

Guest 6 - Name:

Address:

City, State, Zip:

Phone:

Email:

Vegetarian:

Yes
No

Guest 7 - Name:

Address:

City, State, Zip:

Phone:

Email:

Vegetarian:

Yes
No

Guest 8 - Name:

Address:

City, State, Zip:

Phone:

Email:

Vegetarian:

Yes
No

Guest 9 - Name:

Address:

City, State, Zip:

Phone:

Email:

Vegetarian:

Yes
No

Guest 10 - Name:

Address:

City, State, Zip:

Phone:

Email:

Vegetarian:

Yes
No

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