Yes! Count Me In

The 13th Annual UCSD Christini Fund Event
Wednesday, October 5, 2011
at the Robert Paine Scripps Forum

Cocktails and Silent Auction - 6:00pm
Dinner and Live Auction - 7:30pm
Attire -Evening Beach Casual

	* Indicates a field that must be entered to process
Individual:	Please reserve -- Select Number of place(s) -- 1 2 3 4 5 6 7 8 9 10   for dinner at $200 per individual
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Couple:	Please reserve -- Select Number of places -- 1 2 3 4 5   for dinner at $375 per couple
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Table:	Please reserve -- Select Number of table-- 1   for 10 at $1800 per table
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Please place us with these friends:
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State:	-- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   *	Zip:	*
Email:	*
Home Phone:	* e.g. (XXX)XXX-XXXX
Work Phone:	e.g. (XXX)XXX-XXXX
Individual Total:
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The Robert Paine Scripps Seaside Forum

• Direction & Parking
  
• Interior
  

Address:
The Robert Paine Scripps Seaside Forum
8610 Kennel Way, La Jolla, CA 92037

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