NOV. 20 LEE’S PLACE2017 529 BLOOR ST W

8 12 P.M. MIDNIGHT

Please fax or email back to Stephanie O’Brien at 416-445-2644 or stephanie@orea.com

Number attending ____ x $15 = $ _______ Yes I want to Jam with Brian: ____ songs x $25 = $ ________

What would you like to sing and/or play? ___________________________________

What musical instrument do you play? _____________________________________

TOTAL

$

Full Name: _________________________________________ Signature: ________________________

Credit Card: VISA MasterCard Other ___________________________________________

Credit Card Number: ________________________________ Expirty Date: ____________ Validation Code: _______(Reverse of Card)

JAMWITH A PAST

PRESIDENT

The Ontario REALTORS Care® Foundation in Celebrating More Than 40 Years of Giving Back.