Welcome
Number of guests to attend:
Name(s)
Address
Suite #
City
Prov/State
Postal Code
Phone Daytime
Phone Evening
E-mail Address
Please indicate if required:
Vegetarian
Kosher
Please list any guests with whom you would like to be seated:
Enter names here.
If you would like to pay by Visa or Mastercard, please complete the following:
Name
Initial
Card Being Used
Visa
Mastercard
Card Number
Expiry Date
Phone Daytime
Phone Evening
To Pay By Cheque, please send to:
Carrie's Dream Fund at The Hospital for Sick Children
32 Eddy Green Court
Thornhill, Ontario
L4J 2S5