Liam Foundation

Invitation | Registration | Auction Preview

LAUGH-IN EVENT
REGISTRATION FORM

Reservations (* indicates MANDATORY field to be filled in)

*Host Name:

*Address:

*City:

*State:

*Zip:

*Phone:

*Email:

Yes, I would like number of $250 tickets.

I am unable to attend. Please accept the enclosed donation of

(if your donation is $1,000 or more, you will be placed in Liam's "Buy a Smile" club and will receive the 2009 limited edition bracelet as our thanks!)

Guest #1:

To be paid for by:

Host

Guest

Guest #2:

To be paid for by:

Host

Guest

Guest #3:

To be paid for by:

Host

Guest

Guest #4:

To be paid for by:

Host

Guest

Guest #5:

To be paid for by:

Host

Guest

Guest #6:

To be paid for by:

Host

Guest

Guest #7:

To be paid for by:

Host

Guest

Guest #8:

To be paid for by:

Host

Guest

Guest #9:

To be paid for by:

Host

Guest

Guest #10:

To be paid for by:

Host

Guest

Guest #11:

To be paid for by:

Host

Guest

Guest #12:

To be paid for by:

Host

Guest

Dinner Tickets:

$250 x

number of tickets

Donation Amount:

Payment method:

Mastercard

Visa

American Express

Check

Credit Card Info:

Name on Card:
Card #:

Expires:		CVC #:

Please mail cash/checks to:

Liam Foundation
P.O. Box 146
Solana Beach, CA 92075

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