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:: 2012Trivia Night

IN*SOURCE - 2012 Fundraiser

Friday, February 10, 2012
Knights of Columbus
553 Washington Street
South Bend, Indiana
Doors Open at 6:00 p.m. (EST) - Questions Begin at 7:00 p.m. (EST)

Entry fee is $100 for a table of 10!
Silent auction throughout the evening!
Fun games to be played!
Prize for winning table!
Prize for best-decorated table!
Prizes and surprises throughout the evening!
Bring your own food!
Cash bar available!

Trivia Night Registration Form

Count Me In On The Fun!

I want to buy a table! (Tables of 10 are $100)

Names of all participants

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

I want to buy an individual ticket! (Individual tickets ar $10)

Name of participant

I want to contribute to the silent auction!

Donation Description:

Fair Market Value: $

Pick Up/Drop Off/Mail?
Pick Up
Drop Off
Mail

Any Special Limitations/Restrictions/Expirations?

I want to make a cash donation!
Donation Amount: $

Contact me to serve on the committee for next year!

Contact & Payment Information:

Name

Address:

City

State

Zip

Email:

Phone #:

Total Amount for Registration/Contribution: $

Please charge my credit card

Card # Expires:

Pay with PayPal

(If you choose this option, you will be directed to the PayPal site upon clicking the "Register Now" button below)

If you would prefer to mail your registration, donation and check, please send it to INSOURCE, 1703 South Ironwood Drive, South Bend, IN 46613 Attn: Trivia Night

For more information, contact:

Carolyn Honeycutt
(574) 234-7101
(800) 332-4433
choneycutt@insource.org
www.insource.org



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