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URGENT - READ THIS CAREFULLY Please do a separate response card for each payment. People wanting to sit together MUST turn in ALL of their cards & payments together. NO EXCEPTIONS! Tables of Ten Only. (No nines, elevens, or twelves) Please Reserve Ticket(s) at $175 per person for orders delivered or postmarked by August 31, 1994 Q $200 per person for orders delivered or postmarked after August 31, 1994 for the September 24, 1994 BIACK TIE DINNER PLEASE TYPE OR PRINT LEGIBLY Name(s) -"R . I ' eod? 7, /),d. I29M / 1 A50/4- (when paying for multiple tickets, please list all the names of the persons for whom you are purchasing if known) Address .S6/b >SM t s Suite # 7a4' City J4 M StaterL Zip AC/Telephone u_ ' a- - Q Please charge to my l Visa l Mastercard(No AMEX) Card Number-- Expiration Date Signature Q Enclosed are TWO CHECKS, one for $125 payable to "Black Tie Dinner, Inc." and one for $50 payable to the "Human Rights Campaign Fund." (or multiples therof) (For orders after 8/31/94 increase the check to "Black Tie Dinner, Inc." to $150.) I am using my D/FW Federal Club ticket(s) for the Dallas dinner. I am current in my national and local dues. (I am enclosing an additional contribution of $ for my designated local recipient(s).) Q Though I am unable to attend, I want to make a difference with my donation of $ . l. I have made arrangements to sit at L /'Z /'/ '/ ' / 's table. (Table sponsor name) (ORDERS MUST BE TURNED IN TOGETHER WITH ALL OTHERS AT THE TABLE OR THIS REQUEST CANNOT BE HONORED) l I have not made arrangements to sit at a specific table. Please assign me to the next available table. Please distribute the local beneficiatry portion of my money to the following beneficiaries: (check one or more) l AIDS Interfaith Network Q AIDS Outreach Center - Fort Worth Q AIDS Resource Center Q Allan G. Calkin Fund of the Lesbian Gay Rights Lobby of Texas Q ARETE E Cathedral of Hope MCC - Dallas FOR BTD USE ONLY Q Fort Worth Men's Chorus ] Northern Lights Alternatives/ "AIDS Mastery" TABLE # E Oak Lawn Community Services Q Texas Human Rights Foundation TICKET # Q The Women's Chorus of Dallas BATCH # E Turtle Creek Chorale E White Rock Community Church INIT. E All the above in equal amounts (Gf you do not check any box, the local proceeds ofyour ticket will be divided according to the percentages of all designations.) Local recipients receive $50 (or $75 for orders after 8/31). You may consider this amount tax-deductible IMPORTANT INFORMATION Ticket sales begin on July 9,1994 at 8:00 a.m. at the far north entrance to the Loews Anatole Hotel. Table captains (or their representative) may purchase entire tables with all ten seats prepaid and may pick their table (limit 4 tables per person). A lottery will determine the order of selection for captains there before 8:00 a.m. Groups of less than 10 can come and be grouped into tables of 10 (no later changes can be made). Tickets will be distributed at the time of payment.
