Moving Mountains for Hospice

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Guests are seated in tables of eight-if you have less than eight and wish to be
seated with another group that is attending, kindly call the Foundation office
so we can try to accommodate your request.

For more information or if you have additional questions please
contact us at 802.747.3634 or via e-mail.

Please RSVP by July 1, 2009

* Indicates a required field.

REGISTRATION INFORMATION

I would like to purchase tickets at $75 per person.

I/we are unable to attend, but would like to donate in support of the Hospice program.

Name *:
Address *:
City *:
State *:	Zip *:
Telephone *:
E-mail address *:

PAYMENT INFORMATION

Check (I will mail my check payable to the Rutland Health Foundation)

Credit Card (I will call and pay over the phone, Visa • Mastercard • American Express • Discover)

GUEST REGISTRATION INFORMATION

1. Guest Name:

2. Guest Name:

3. Guest Name:

4. Guest Name:

5. Guest Name:

6. Guest Name:

7. Guest Name:

8. Guest Name:

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