Monte Carlo Casino Night

July 9, 2011
The Purcell Home
2307 Harewood Drive - Livermore - CA - 94551

1) Complete this form
2) Print it
3) Mail it in

Yes, I plan to attend!
No, I can't attend, but I'd like to show my support.

  Number of Guests   Total
Please register guests @ $40 each for Casino Night  
and/or register guests @ $50 each for Casino Night plus Texas Hold 'em  
I'd like to make a donation in this amount to support your important work
  Grand Total  

Please hold this registration at the door in the name of

Please make your check payable to "Elena Macias Foundation."

Elena Macias Foundation • 2307 Harewood Dr. • Livermore CA 94551