No, I cannot attend but would like to make a donation.

Yes, I would like to attend and sponsor at the following level:

Choose sponsor option ----- River God — $1,000.00 Fishing Guide — $500.00 Keen Kayaker — $250.00 Busy Beaver — $100.00 Paddler — $50.00 Other None

Yes, I would like to attend—send me the following number of tickets:

Choose ticket option ----- One ticket — $50.00 Two tickets — $100.00 Three tickets — $150.00 Four tickets — $200.00 Five tickets — $250.00 Six tickets — $300.00

If you prefer to RSVP via mail, please print and send the form to:
Friends of Debra Shore, PO Box 4674, Skokie, IL 60077.

Personal information (credit card billing information):

Name* (First, Middle Initial, Last)

Ms. Mrs. Mr. Dr. Hon.

Organization

City*, State/Province*, Postal Code*

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 American Samoa Guam Puerto Rico Virgin Islands Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Northwest Territories Ontario Prince Edward Island Quebec Saskatchewan Yukon

Contact information:

Your e-mail address *

Your phone number

Information required by state law:

State law requires that political committees report the occupation and employer of
individuals whose contributions exceed $500.

Employer

Occupation

No Employer

Select One Retired Self-Employed Homemaker