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Saturday, June 4, 2011
Dale F. Halton Arena – James H. Barnhardt Student Activity Center
Reservation Form
Individual / Company Name:
Address (include City and Zip):
Contact Person:
Daytime Phone #:
Email Address:
Number of Reservations
(Cost: Table of Ten – $1,000; Individual – $100):
1
2
3
4
5
6
7
8
9
10
*Note: Changing the Number of Reservations will clear any information entered below in the Attendees information section
Please indicate the table name / sponsor:
Names and Addresses of Attendees
Name:
Address (include City and Zip):
Payment Method
Please Bill Me (Payment due prior to event)
Or you may send your payment via mail to the address below:
Charlotte 49ers Athletic Foundation
9201 University City Blvd.
Charlotte, NC 28223-0001
Phone: 704-687-6024
Fax: 704-687-6247
Please verify the above information is correct before submitting your request.
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