2012 Gala Ticket Form

2012 Induction Ceremony and Fundraising Dinner Thursday, August 16, 2012 Tickets Mississauga Convention Centre 75 Derry Road West Mississauga, ON 5:30 pm – Cocktail Reception & Silent Auction (Cocktail Attire) 7:00 pm – Dinner and Induction Please complete the form below and return by mail or email to: Canadian Horse Racing Hall of Fame C/o Linda Rainey 168 Royal Orchard Blvd. Thornhill, ON L3T 3E5 [email protected] 416-417-9404  Please reserve _________ seats at $175.00 each.  I wish to sponsor a table of eight for $1,700.00. This includes eight tickets, a donation of $300.00 to the Canadian Horse Racing Hall of Fame as well as recognition in the commemorative program. Table sponsorship reserved in the name of: ___________________________________ Please list the names of the guests that you would like seated at your table. Tables seat eight (8) people. Guest Name 1. 2. 3. 4.

Special Dietary Requirement/Food Allergy

Guest Name

Special Dietary Requirement/Food Allergy

5. 6. 7. 8.

MAILING ADDRESS: ___________________________________ CITY:________________________________________ PROVINCE:______________ POSTAL CODE: ____________________PHONE NUMBER:_________________________ EMAIL ADDRESS: _____________________________________ PLEASE FIND ENCLOSED $

FOR MY TABLE SEATS IN THE FORM OF:

 CHEQUE (Payable to the Canadian Horse Racing Hall of Fame) or  VISA / MC #_______________________________EXPIRY_____________ NAME ON THE CARD:________________________SIGNATURE:_____________________________________________