Parkinson's Benefit Ball

...A life time of love and support

Please complete and submit a separate registration form for each guest.

Please RSVP by July 16, 2019

Name *
Name
Phone Number
Phone Number
Meal Preference *
The standard dinner menu includes: Salad, Bread & Butter, Chicken Entree, Vegetable Sides, and Dessert. We are able to accommodate dietary restrictions so please indicate your choice below. Please use the message box below to inform us of any other dietary restrictions (i.e. vegetarian, vegan, gluten-free, need food to be pre-cut, etc.).
Please indicate any seating preferences (near exit, beside another guest, etc.). Dinner will be served according to your seating assignment. If you would like to sit with another guest, please indicate the guest's name(s) and ticket number(s). We will try our best to accommodate your request. If we cannot, we hope you understand.

For More Information, Please Contact

Samyu Ravi at (717) 265-6379

or Email: parkinsonsfirstpa@gmail.com