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Mystery Dinner Registration Form

* # of guests attending the event

Attendees must be 21+

Guest names

(First Last, First Last, etc.)

Any dietary restrictions?

(Please list guest name followed by their dietary restriction(s).)

Child care:

Child care is offered during the event for $20 per child and includes a pizza dinner.

# of children

Name a TIki centerpiece:

Join our TIki family!

Yes, I want to name a TIki centerpiece in someones honor.

Tiki name(s) (as you'd like them to appear on the centerpieces)

Payment required to name a TIki.

Event sponsorship:

If you're interested in becoming a sponsor of this event, please check the box below and someone will get back to you as soon as possible. Thank you!

Sponsorship:

YES, please contact me with sponsorship information!

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Total:

Mystery Dinner Registration Form

Child care:

Name a TIki centerpiece:

Event sponsorship:

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

Mystery Dinner Registration Form

Child care:

Name a TIki centerpiece:

Event sponsorship:

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

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