Early Bird Dinner Theater “The Cemetery Club” – July 30th Reservation Information Event* Early Bird Dinner - "The Cemetery Club" Name* First Name Last Name Home PhoneCell Phone*Email Address* I will drive* Yes No My car accommodates* Total including yourselfHiddenSection BreakHiddenAre you bringing a spouse or social significant other?* Yes No HiddenIs your Guest your spouse?* Yes No Name of Spouse or Social Significant other:* HiddenGuest InfoA guest waiver must be submitted, The waiver is located under the Activities menu and Trips. HiddenName of Guest* First Name Last Name HiddenGuest Phone*HiddenGuest Email* HiddenGuest WaiverNeededReceivedTrip Cost: Price: Guest total Price: Total Form of Payment* Credit Card Check Credit Card InfoBilling Name*As it appears on your credit card. First Last Billing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Payment is due within seven days of registration. Make checks payable to: Palm Harbor Newcomers Club (PHNC) Mail to: Palm Harbor Newcomers Club Attn: Trips, 9609 Gretna Green Dr. Tampa, FL 33626 EmailThis field is for validation purposes and should be left unchanged.
