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 Host
Name*
First Last
Phone Number*
Will host be seated at this table?*
- Yes
- No
Guest 1
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Email
Dietary restrictions/needs?
Guest 2
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Email
Dietary restrictions/needs?
Guest 3
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Email
Dietary restrictions/needs?
Guest 4
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Email
Dietary restrictions/needs?
Guest 5
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Email
Dietary restrictions/needs?
Guest 6
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Email
Dietary restrictions/needs?
Guest 7
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Email
Dietary restrictions/needs?
Guest 8
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Email
Dietary restrictions/needs?
Guest 9
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Email
Dietary restrictions/needs?
Guest 10
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Email
Dietary restrictions/needs?
VIP Reception
Please 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.

Office & Mailing Address:

SSI
4407 W. St. Joe Hwy.
Lansing, MI 48917

Phone: 517-321-6233

Email: ssi@ssionline.org

Table Host Form

Table Host

Guest 1

Guest 2

Guest 3

Guest 4

Guest 5

Guest 6

Guest 7

Guest 8

Guest 9

Guest 10

VIP Reception

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Office & Mailing Address: