Go Red Reservation Form

Please print this page, complete the form, and mail with payment to:

SMH Foundation,
Attn: Mary Jo Deprey, Go Red
P. O. Box 1628
Grand Junction, CO  81502

Seating is limited. Reserve early. Deadline is February 16, 2016.

ATTENDEE INFORMATION:

Name: 
Address: 
City/State/Zip Code:    
Email (for reservation confirmation): 
Daytime phone: 

___ Please reserve _____ spots at Go Red for Women at $30 each 

___ Please reserve a table for 10 at $350

Total: $______________  

I/we will take advantage of the free screenings (check one). 
_____ Yes   _____ No 

Dinner choice (check one):  
_____ Chicken
_____ Salmon
_____ Vegetarian  

I AM PAYING BY:
____ Check payable to: SMH Foundation–Go Red

____ Credit card
Name as it appears on card:
Card number:  
Expiration date:
CCV#:
Reservations with credit card payment can also be faxed to 970-298-7784.

SEND FORM AND PAYMENT TO:
SMH Foundation
Attn: Mary Jo Deprey, Go Red
P. O. Box 1628
Grand Junction, CO  81502

QUESTIONS:
Call 970-298-1996 or email: GoRedForWomen@sclhs.net