Please Reserve Seats for Me at the 2002 Vintage Charity Ball!

Please Reserve A Limo Ride to the Ball for Me!

First Name:
Last Name:
Address:
City:
State:
Zip:
Phone:
Number of Seats to Reserve:

Enter the Number of each menu selection you would like to reserve.

Steak DeBurgo--Twin 3 ounce medallions of Filet Mignon charbroiled to a medium well temperature and smothered ina rich De Burgo sauce, made with burgundy wine, mushrooms, and beef au-jus.
Stuffed Tilapia--A filet of tropical white fish with a sweet mild flavor stuffed with crabmeat and assorted cheeses topped with fresh tarragon and Parmesan cheese and oven baked.
Apple, Raisin & Almond Chicken Breast--Tender chicken breast lightly breaded and stuffed with a sweet all-natural apple, raisin and almond stuffing.

Enter the total amount of your donation ($50.00 per person):

Please make check payable to CIS and mail them to:
500 High Avenue West
Oskaloosa, IA 52577

Limousine Service Order Form

Verschuure Limousine Service will provide a limousine ride to and from the 2002 Vintage Charity Ball for a $10 per person donation to Crisis Intervention Services. The limo seats 8 people. If there are enough people at a single pick-up point to fill the limo, we will discount the ride to $70 per pick-up. Limousine service will be available beginning at 5:30 p.m. We will do our best to schedule pick-ups at times requested, but cannot guarantee it.

First Name:
Last Name:
Address:
City:
State:
Zip:
Number of Passengers:
Desired time for pick up (aprox.): p.m.
I will send my check for: (# seats x $10)

Please make check payable to CIS
500 High Ave. West
Oskaloosa, IA 52577