Georgia Mountains Hospice
&
Knights of Columbus Blue Ridge Council 12126



Saturday, September 19, 2015
6:30pm -11:00pm
(Favorite Jeans, Boots & Fabulous Bling)
A Spectacular Evening of Dinner, Music, Dancing, and Silent Auction

Willow Creek Falls & Vineyard ~ Blue Ridge, GA

We are offering a discounted price for early ticket sales, so reserve your table today.

“Best Deal” ~~~ July 1 – August 20 ~~~ Table of 8 for $500.00
July 1- August 20~~~$65.00 per ticket or a table of 10 for $600.00
August 21- September 10 ~~~$75.00 per ticket or a table of 10 for $650.00
September 11-September 19~~~$85.00 per ticket~~No Table Discount Available

______ I am unable to attend, please accept my donation in the amount of $__________________
Georgia Mountains Hospice is a non-profit, 501 (c) (3) organization, therefore your donation is tax deductible.


Please return this form (bottom of page) along with your check made payable to Georgia Mountains Hospice at 70 Caring Way, Jasper, GA 30143.  Contact Gina Pendley, for more information or questions at 706-253-4100, 800-692-7199 or email gpendley200@ellijay.com.

Attendee Name                                                                     Attendee Name                                                        
Attendee Name                                                                     Attendee Name                                                        
Attendee Name                                                                     Attendee Name                                                        
Attendee Name                                                                     Attendee Name                                                        
Attendee Name                                                                     Attendee Name                                                        
Amount Enclosed $                                                               Phone #                                                                     
Address                                                                                                                                                                     
City                                                                               State                                       Zip                                                    

Email Address: