Registration

2019 Annual Banquet Registration

Annual banquet and benefit auction ticket registration form


Every February we hold our annual Banquet and Fundraiser. We have an excellent meal, a silent auction, a live auction, and raffle/games.


Event Information

Date: Saturday, February 23, 2019
Time: Doors open at 5:00 PM
Location: River Creek Club
Address: 43800 Olympic Blvd, Leesburg, VA 20176
Phone: 703-779-2022
Dinner: Serves at 7:00 PM
Dinner Menu: All served with a House Salad and Dessert. Attendees can choose from Steak, Crab Cakes or Vegetarian.
Live Auction: Starts at 8:00 PM

Registration Form

For each person, please include name, email address and entrée choice.

Your First Name:*

Your Last Name:*

Your Phone Number:*

Your Email Address:*

Address:*

City:*

State:*

Zip Code:*

Company Name:

How many tickets would you like?


Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Attendee First Name:*

Attendee Last Name:*

Attendee Email Address:*

Entree:
SteakCrab CakesVegetarian

Total: 0

Payment Information:

  • Pay via PayPal; you can pay with your credit card if you don't have a PayPal account.
  • Make your payment directly into our bank account. Please use your email as the payment reference.


Seating will be assigned by Banquet Committee – Persons wishing to sit together should email the Banquet Coordinator with your seating request. 

Cindy Hickerson, Banquet Coordinator
Email: cindy.hickerson@gmail.com

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