Boys and Girls Clubs of the Peninsula: The Positive Place for Youth

Be a Kid for a Night 2008

YES! I / We would like to support the Boys & Girls Clubs of the Peninsula and Be a Kid for a Night. I / We will participate at the following level:

Please reserve seat(s) for me / us at the Kid at Heart level ($200 per person)

Total:

Donor Information (*denotes required information)

Name:

Company/Org

Mailing
Address*:

Street*:

City*:

State/Province*:

Required for the US, Canada, and Mexico

Postal/zip code*:

Phone:

- (In case we need to contact you)

E-mail*:

Payment Information

Please bill me

I/we will mail in my/our payment to the following address:

Boys & Girls Clubs of the Peninsula
Be a Kid for a Night 2008
401 Pierce Rd.
Menlo Park, CA 94025

I/We would like you to charge my/our entry fee to a credit card. (See below)

Credit Card Information (Select one)

Name
(As it appears on Card)

Card Number:

- - -

Exp Date

Billing Address (if different then above)

Name on Card

Street Address

City:

State:

Zip Code:

If sponsoring a table, please list the names of the guests you would like seated with you.

Name

Special Needs:

We are grateful to our invitation sponsor

Rev: 03/18/2008