Table Host Form Please use this form to submit the names and contact information of guests at your table(s) for the 2017 SSI Annual Fundraising Banquet. If you have any questions, call 517-321-6233 or email office@ssionline.org. Table HostName* First Last Phone Number*Will host be seated at this table?* Yes No Guest 1Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail Dietary restrictions/needs? Guest 2Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail Dietary restrictions/needs? Guest 3Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail Dietary restrictions/needs? Guest 4Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail Dietary restrictions/needs? Guest 5Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail Dietary restrictions/needs? Guest 6Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail Dietary restrictions/needs? Guest 7Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail Dietary restrictions/needs? Guest 8Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail Dietary restrictions/needs? Guest 9Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail Dietary restrictions/needs? Guest 10Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail Dietary restrictions/needs? VIP ReceptionPlease enter the names of the two people attending the VIP reception: If you have purchased multiple tables, please fill out this form for each table. The page will refresh when you click submit. Learn More Volunteer Student Self-Diagnostic Guide Office & Mailing Address: SSI4407 W. St. Joe Hwy.Lansing, MI 48917 Phone: 517-321-6233 Email: ssi@ssionline.org