Annual Dinner Request (Test Version)
$
0
Total
Name
Name
*
First
Last
Address
Address
*
Street Address
Address Line 2
City
State / Province / Region
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal / Zip Code
Country
United States
Phone
Phone
*
-
###
-
###
####
Email
Please choose the number of seats you wish to purchase.
Member Seat:
$35
Non-Member Seat:
$50
Number of Member Seats Requested ($35)
1
2
3
4
5
6
7
8
9
10
Number of Non-Member Seats Requested ($50)
1
2
3
4
5
6
7
8
9
10
Method of Payment
*
Withdraw from HLEFCU Account
Check
HLEFCU Account Number (if paying from account)
Account Type
Checking
Savings
Suffix
1
75
76
77
78
Please list the first and last name of everyone on your table.
*
Please select your first choice table number.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
Please select your second choice table number.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
Please select your third choice table number.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
Please select your fourth choice table number.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
Special Requests
HLEFCU Notes
$
0
Total